Overcoming treatment fears

Dr Paula Diab describes several treatment fears that stand in the way of well-managed diabetes.

“Nothing in life is to be feared. It is to be understood.” – Marie Curie

Marie Curie is often spoken about in recognition of her pioneering work in radioactivity that allows us to walk into an X-ray department, casually and fearlessly, and view if a bone is broken or if we have pneumonia. She was the first woman to win the coveted Nobel Prize and the first person to ever win it twice in two different scientific fields! She and her husband were also the first married couple to win a Nobel Prize and she became the first woman to become a professor at the University of Paris. And all of this she achieved almost four decades before she was even allowed to vote. She clearly didn’t fear progress or change at all.

How fear plays a role

People with diabetes tend to live in a constant state of fear: What happens if I eat this? Will my blood glucose drop? Is it safe to go for a run? What will my doctor say if s/he sees my results? The list is endless. However, fear is counteractive to any type of progress and if we’re going to conquer diabetes and manage it correctly, we need to be one step ahead and not afraid of progressing.

A few years ago, I saw a young lady who was taking maximum oral therapy. She had been a patient of mine for a few years and we had developed a rapport between us. Her HbA1c had increased over time and at every visit, I had gradually started introducing the topic of insulin. My persuasions were met with absolute fear and obstinate rejection. So much so that I was surprised that she continued to return every six months as I thought that she would seek care elsewhere. Her fears to commencing insulin were rooted in her contextual story that included relatives passing away from complications of diabetes and the perception that she had failed in her diabetes management if I was suggesting that she needed insulin.

Fast forward to a few months ago when a happy, content and well-managed patient walked briskly into my office laughing, saying she can’t believe how silly she must have look a few years ago when she was crying and refusing insulin. This patient now injects twice a day with no problems, knows how to adjust doses depending on her activity and meals, and feels so much healthier. Her HbA1c has improved, the mild retinopathy she had has resolved, she has lost weight and now manages her diabetes instead of her diabetes managing her.

Changing treatment fears

What changed? She no longer fears insulin but understands it; that insulin comes in the form of an injection just like oral medications come in the form of tablets. That is how insulins are manufactured. She understands that insulin isn’t the end of the road in diabetes and that many new research papers are starting to advocate the benefit of early onset, very low dose insulin in some cases. She also understands that timely intervention can resolve some complications and prevent others. Now, she understands that there is no such thing as failure in diabetes but rather a different treatment path that needs to be followed.

Diabetes isn’t a disease that can be treated with a bi-annual, 15-minute check-up and six-monthly script. There are so many daily influences on how glucose levels react, and we need to understand how these factors relate to manage diabetes correctly. When you fear insulin initiation or any other aspect of diabetes management, you’re placing unnecessary obstacles in your way that will hinder progress. Hopefully, in understanding these obstacles, they can be overcome.

Fear of insulin

This is probably the most common fear that people with diabetes have. It’s a misconception that only children with Type 1 diabetes will need insulin. If you live long enough with diabetes, you’ll eventually need insulin.

Insulin isn’t dangerous if used correctly and shouldn’t be painful to inject. Using insulin doesn’t have to place restrictions on your lifestyle. Make sure that your healthcare provider shows you how to inject correctly and change the needles. Very often, preventing a painful injection can be as simple as using the correct technique and changing needles regularly.

If given in the correct dose and monitored correctly, insulin isn’t dangerous. It reduces your blood glucose levels but that is what it’s meant to do.

You need to monitor your glucose levels and understand what will cause a precipitous drop and how to avoid those situations. This requires a good doctor-patient relationship, specialised diabetes education and regular glucose testing. Knowing how to manage a lower glucose level and what to do in the case of an emergency are just as important as knowing how to inject the insulin.

Many people also have the idea that to inject, you have to leave the room and do so in private without anyone knowing. Again, this doesn’t have to be the case.

In addition, many newer regimens involve insulin given only at night or an injection given in the morning to control glucose levels throughout the entire day. It may not be necessary to take insulin before each meal when you first start insulin. It can be as simple as when you brush your teeth at night, you take your injection. These are just a few examples of the fears surrounding insulin usage, all of which can be managed through understanding more about the medication and seeking professional advice.

Fear of disease progression

Diabetes is a chronic, progressive disease which means that from the day that you’re diagnosed with diabetes, it will naturally become more of a threat to your general health. In fact, recent evidence shows that by the time you’re diagnosed with Type 2 diabetes, you’ll already have lost 50% of your beta cell functioning in the pancreas and that this loss of function will decline throughout the course of the disease.

This is a good reason to always be one step ahead of your diabetes. Don’t wait until your vision deteriorates before you seek help, get your eyes checked regularly even if you think you can see fine. Don’t wait until wounds start healing poorly or you have cardiac symptoms before you seek specialised care. From the very outset, your healthcare team should be looking for these complications and advising on how they can be prevented.

The disease will progress. The medication that you took two years ago may no longer be effective. Complications will occur. But the trick is to manage these complications, mitigate the risk factors and regularly seek specialised care to help you understand where the risks are and how they can be managed.

Fear of hypos

In a previous article, I spoke about the fears of hypoglycaemia and how to manage them. Hypoglycaemia is a very real threat and is the cause of significant morbidity and mortality every year. However, if you know how to predict and treat hypos and have the correct support in place, this risk can be managed.

Newer insulins and medications have a far lower hypo risk than previous preparations did and are generally safer to use. However, being educated and aware of hypoglycaemia is still the best solution.

Fear of seeing the doctor

Often, I joke with my patients that I don’t have a police hat nor a big stick. As healthcare providers, our role isn’t to chastise patients who don’t behave or to point out all the negative aspects of their management. Our role is rather to guide and educate. Obviously, we do have to identify the short-comings to know where to make changes but thereafter, the solution to fixing the problem is to understand it and give guidance on how to change.

Don’t delay in seeking healthcare and seeking the best type of care you can access because you’re afraid of what the doctor will think or say. The patients who cause us distress are those who are unstable, and we don’t understand, not the ones who need and ask for our help.

Get rid of treatment fears by understanding

The only time diabetes needs to be feared is when left unmanaged as it has complications that can be life-threatening. It requires careful lifestyle management and daily attention to manage it correctly. But it shouldn’t be feared, rather understood.

If you have never seen a diabetes educator, ask your doctor or pharmacist who you can contact in your area to help you understand this curious disease. Seek to understand and embrace your diabetes. In the end, a diabetes lifestyle is a healthy lifestyle that everyone should be following.

Being afraid of diabetes is going to be an obstacle to managing it well. Seek to understand more about the disease, its complications and how it can be managed, and you’ll find yourself walking briskly into your doctor’s office laughing at how unfounded your initial fears really were.  

Dr Paula Diab


Dr Paula Diab is a diabetologist at Atrium Lifestyle Centre and is an extra-ordinary lecturer, Dept of Family Medicine, University of Pretoria.

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