Skipping Insulin May Not Be Uncommon

TUESDAY Jan. 26, 2010 -- More than half of the people who need to take insulin to control their diabetes skip an injection now and then, a new study reports.

The researchers found that people with diabetes forgo their insulin injections for a number of reasons, including pain and embarrassment, and that their reasons vary depending on the type of diabetes they have.

"More and more people will be taking insulin, and it's really important that they learn to manage this powerful medication effectively," said the study's lead author, Mark Peyrot, a professor of sociology at Loyola University Maryland and an assistant professor at Johns Hopkins University School of Medicine, both in Baltimore.

About one-fourth of the people who have diabetes -- either type 1 or type 2 -- take insulin, according to the study, which is published in the February issue of Diabetes Care. Insulin is a hormone that helps regulate blood sugar levels. Without insulin, the body's cells can't use sugar to fuel muscles. Insulin can only be taken through injections or an insulin pump.

People with type 1 diabetes, an autoimmune disease, no longer produce insulin on their own and depend on insulin injections to survive. People with type 2 diabetes still have some natural insulin, but they might not have enough or they might be resistant to insulin and require more than their body can provide.

Skipping a necessary insulin dose causes blood sugar levels to rise. And, with persistent high blood sugar, a person's risk for serious complications, such as blindness and kidney failure, increases.

In their research, Peyrot and his colleagues asked 502 people with diabetes who used insulin to complete an Internet survey.

More than half of those surveyed, 57 percent, said they had intentionally missed an insulin dose, and 20 percent said they regularly skipped insulin injections.

Overall, people were more apt to miss an insulin dose if they were younger, had a lower income, had completed more schooling, had type 2 diabetes, did not follow a healthy diet, were required to take more injections, complained of injection pain, were embarrassed by the need for insulin or thought that the injections interfered with their daily life.

Not adhering to a good diet was the biggest reason that people with type 1 diabetes skipped their insulin dose -- something that Peyrot said is not always a negative. That's because people who get too much insulin are at risk of hypoglycemia (low blood sugar). If they skip a meal because they're busy, for instance, they may need to skip the insulin dose they were scheduled to take so that their blood sugar levels don't drop too low.

And, he explained, that's probably why people with higher education levels were more likely to miss insulin. "It's possible that it's not ignorance, that it may be a thoughtful process in this case," Peyrot said.

Among people with type 2 diabetes, the risk factors associated with insulin omission included age, education, income, pain and embarrassment.

"Some of these factors are modifiable," Peyrot noted. Using insulin pens with fine-gauge needles, for example, could eliminate some of the pain and embarrassment associated with the injections, he said.

But he also described what he called a "disconnect" between diabetics and their doctors.

"Even when patients ask, providers might not be giving them enough help in overcoming modifiable risk factors," Peyrot said. "Physicians need to be alert. Patients may tell you their problem rather than ask for help. It's a hint."

Katie Weinger, an investigator of behavioral and mental health research at Joslin Diabetes Center in Boston, said that missed insulin doses "is a really important issue in the treatment of diabetes." She co-authored an accompanying editorial in the journal.

"Diabetes is a very challenging disease," Weinger said. "You need to have a well-organized, unchaotic life in order to fit diabetes into it smoothly. And, for older people who've lived one way for 50 or 60 years, to have to change lifelong habits and take all these medications for high blood pressure, high cholesterol and their heart, and then you put insulin into the mix -- it can be overwhelming," she explained.

"People with diabetes don't need to give up their quality of life, but they need to find a happy balance between treating and living well with diabetes," she said. "And, when possible, treatment regimens may need to be simplified."

More information

The American Diabetes Association has more on managing diabetes.

Posted: January 2010


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