Quality Standards for Diabetes Care Toolkit

Best Practice Advocacy Centre (BPAC 2012) includes the following information:

General practitioners may be reluctant to begin insulin treatment due to:

the complexity of the training required to educate the patient

a lack of time and resources to perform adequate consultations and follow-up

a lack of practice training and access to educators

concerns that insulin increases the risk of hypoglycaemia

concern that patients will view insulin as a ‘shortcut’ and become less compliant with oral hypoglycaemic medication and lifestyle changes

the possibility of weight gain that is associated with insulin treatment.

These issues need to be carefully considered and practice strategies put in place to address any barriers to providing treatment.

In addition, patients may be reluctant to begin insulin treatment due to:

the fear of injections and the inconvenience of performing them

the need for regular monitoring of blood glucose levels

social discomfort surrounding the need for injections, or fear of loss of employment if their job involves driving

a feeling that insulin initiation means that they have failed and are ‘at the end of the line’

concern over adverse effects such as weight gain and hypoglycaemia that are associated with insulin.

In order to allay concerns, it is important that patients understand that having type 2 diabetes means they have a progressive shortage of insulin to manage glucose levels over time and that medicine needs will change – beginning insulin does not mean that they have failed. Insulin types and delivery systems have improved over the years and injections now cause minimal discomfort while allowing discreet use. Many patients also report increased energy levels and wellbeing following insulin initiation.

It is usually beneficial to include the patient’s partner or family in discussions about insulin initiation. If patients are particularly reluctant, a two-month trial period can also be suggested, after which point the patient can reassess their decision.