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Feature Article

Psychogenic insulin resistance

Pat Phillips

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Abstract

Insulin should be considered an expected step in the treatment of type 2 diabetes. Overcoming the patient’s (and perhaps your) resistance to starting insulin is a major step in initiating insulin therapy.

Key Points

  • Having to start insulin therapy in type 2 diabetes can be perceived by both doctor and patient as indicating failure in controlling the condition.
  • Along with the failure may come shame and blame, a sense of inadequacy in dealing with the new challenge of starting insulin, and fear of perceived bad outcomes associated with insulin (weight gain, highs and lows causing comas, complications of sight and/or limb loss, loss of independence) and the pain of injections.
  • The doctor and the patient both need a lot of help to start insulin therapy. They may have to work through their sense of failure and inadequacy and to face their fear of what starting insulin may be associated with.
  • Once the doctor and the patient have accepted that insulin is an expected step in the treatment of type 2 diabetes, the KISS approach (‘keep insulin safe and simple’) is a simple and practical way of initiating insulin therapy.
  • The essentials of the KISS approach are to start with one insulin preparation, one dose per day and one titration schedule and to initially target just one blood glucose level a day (usually the fasting level).

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