Supporting People Transition to Insulin
Unfortunately, many people with type 2 diabetes will require medication to manage their condition during the course of their lifetime. This will be in addition to maintaining a healthy lifestyle through diet and exercise. In the past 12 months alone, over 17,000 Australians with type 2 diabetes commenced insulin therapy.3 While insulin is the most effective blood glucose lowering medication available, barriers can prevent successful transition. Below we discuss insulin therapy and strategies on how to overcome both patient and clinician barriers to insulin transition.
Barriers to insulin transition
Negative thoughts or feelings about insulin transition are not uncommon in people with diabetes, and as a result, delays in insulin commencement may occur. Delaying insulin therapy when it is indicated can make achieving blood glucose targets more difficult. Furthermore, prolonged periods of high blood glucose levels increase the risk of complications.5
Despite this, delays in transitioning to insulin are common. With both clinician’s and individual’s concerns contributing. For the person with diabetes, the greatest challenge can be overcoming psychological factors such as:
- anxiety about injections
- feeling like the progression to insulin is a ‘personal failure’
- associating insulin use with negative outcomes (i.e. amputation) or side-effects (i.e. hypoglycaemia or weight gain)
For clinicians, limited time and appropriate skills can be factors. As can a lack of support from other clinicians with more experience and expertise, for example, access to Credentialled Diabetes Educators.
How to overcome barriers to insulin transition
Talk about insulin therapy early
It is important to start talking about insulin early. Preferably soon after diagnosis. Openly discuss any concerns a person with diabetes may have around insulin use. In fact, The Insulin Treatment Appraisal Scale (ITAS) is a useful tool that can help with concerns about insulin. It can also help clinicians understand personal barriers, provide information and dispel common myths (the ITAS can be found on page 86 of the NDSS Diabetes and emotional health handbook)
Set realistic expectations around insulin therapy
Set realistic expectations on the use of insulin therapy to manage type 2 diabetes. For example, when a client first starts insulin therapy, it’s important they understand their dose will change. Frequent visits and telephone support are recommended following the start of insulin therapy. This is because insulin doses may need to be increased or decreased until desired blood glucose targets are achieved. Clients may be anxious about increasing their insulin doses. They may also feel that insulin is not working for them. Despite this, you can support them by explaining that lower doses are used at the start of insulin therapy, so insulin can be introduced safely. This will help minimise the risk of hypoglycaemia. Reassuring clients that this is the recommended process, may help them to feel confident with insulin and to continue to use it.
Refer to other specialist health professionals
A Credentialled Diabetes Educator can support clients transitioning to insulin therapy by providing education on:
- how insulin works and the timing of injections
- the effects of food and exercise
- correct injection technique
- hypoglycaemia prevention, including recognition and treatment and how to do a insulin dose adjustment
Referral to an Accredited Practising Dietitian can support clients to avoid or minimise the potential weight gain associated with insulin therapy.
Use resources to help explain insulin therapy
Resources such as demonstration insulin pen devices and injecting pads can help familiarise clients with how insulin is delivered. Furthermore it allows them to practice doing ‘dummy’ injections which can help to alleviate fears associated with injections.
Health Professional resources to help you support people with diabetes successfully transition to insulin:
- Starting insulin: an information booklet for people with type 2 diabetes who want to find out more about insulin and what it might mean for them
- Concerns about starting insulin (for people with type 2 diabetes) Fact Sheet
- Diabetes and emotional health handbook
- ADEA Clinical Recommendations – Subcutaneous Injection Technique
- Diabetes Webinar Series – insulin treatment part 1 and 2
- Injection Technique Best Practice Webinar
Consumer resources to help people living with diabetes to successfully transition to insulin:
- Living with Insulin Online is an interactive, self-paced educational hub designed to increase knowledge and confidence for people using insulin.
- Living with Insulin Face-to-Face group education programs are delivered by Diabetes NSW & ACT and Diabetes QLD.
- Furler, J. et al. (2017). Supporting Insulin Initiation in Type 2 Diabetes in Primary Care: results of the Stepping Up pragmatic cluster randomised controlled clinical trial. British Medical Journal, 256:j783.
- Hendrieckx C, Halliday JA, Beeney LJ, Speight J. Diabetes and emotional health: a handbook for health professionals supporting adults with type 1 or type 2 diabetes. Canberra: National Diabetes Services Scheme, 2016.
- NDSS data snapshot June 2020 NDSS data snapshot June 2020 https://www.ndss.com.au/about-the-ndss/diabetes-facts-and-figures/diabetes-data-snapshots/
- Polonsky, W. et. al. (2017). Initiating insulin: How to help people with type 2 diabetes start and continue insulin successfully. International Journal of Clinical Practice, 71: e12973.
- The Royal Australian College of General Practitioners (RACGP), 2000. Management of type 2 diabetes: A handbook for general practice. East Melbourne, Vic: RACGP