Experiences of people with type 2 diabetes who have changed from oral medication to self‐administered insulin injections

Abstract

It has been estimated that the majority of patients with type 2 diabetes mellitus will need treatment with insulin eventually if they are to keep their blood sugar levels within recommended limits. Whilst much is known about the physiological benefits of insulin, far less is known about the 'lived experience' of going onto insulin therapy. The purpose of this study was to elucidate the range of subjective experiences of men and women with type 2 diabetes who have recently gone onto insulin. It was specifically concerned with their expectations and experiences of insulin and the impact they felt it made on their lives.A purposeful sample of six people with type 2 diabetes mellitus, who had recently commenced on insulin therapy, was taken. Data were collected using semi-structured interviews which were audiotape-recorded and transcribed. The transcripts were analysed together with the researcher's observational notes and documentary evidence, using interpretive phenomenological analysis.The data showed that patients experienced a range of initial reactions (from shock and anger, to relief) and perceptions of insulin, sometimes resulting in an altered selfimage. However, perceptions were shown to change over time, with some patients eventually accepting insulin and becoming empowered.It was concluded that patients starting on insulin need a programme of education and support which is not solely directed at imparting knowledge and new skills. Health care professionals must first establish patients' health beliefs, expectations and fears regarding insulin, if this knowledge is to be accepted and new skills are to be used effectively.

Psychological insulin resistance: patient beliefs and implications for diabetes management

“…This sense of failure may be the result of feeling that insulin is required because they have ''failed'' other therapies or failed to control their disease [10,12,19] by not properly caring for themselves [1,23], or being able to self-manage their disease with diet, exercise, or oral medications alone [11]. This sense of personal failure may leave the patient with feelings of failure and guilt [22] and a belief that they will be unable to control the disease in the future, regardless of treatment, and that insulin will not be effective and will not make a positive difference to their overall health [14,20,24,25,27].…”

“…This sense of personal failure may leave the patient with feelings of failure and guilt [22] and a belief that they will be unable to control the disease in the future, regardless of treatment, and that insulin will not be effective and will not make a positive difference to their overall health [14,20,24,25,27]. Insulin may also be perceived as a threat or punishment, resulting in anger or betrayal, because patients may feel unfairly punished for poor self-care [12,28].…”

“…Additional negative self-perceptions and attitudinal barriers that may play a part in PIR include: wishful thinking that insulin is not necessary, procrastination regarding treatment [21], the belief that people treat insulin users differently [19], that they are no longer ''normal,'' that they are now dependent or like a drug addict [12,29], or that they are inadequately educated or ill-equipped to handle the daily demands of insulin therapy [28].…”

“…Specifically, technical concerns have been shown to include: anxiety about mastering the skill of giving oneself an injection, the general hassle of taking injections [8,12], concern about preparing the correct dose of insulin [30], apprehension about the proper technique of needle injection [23], poor self-efficacy, concerns about skills related to administering an injection [31], as well as a general lack of confidence regarding the ability to handle the demands of insulin therapy/regimen [24,25]. Anticipated fear that the injections may be painful also contributes to a general anxiety about injections [18-20, 22-25, 29].…”

“…PIR represents a complex set of beliefs about the meaning of insulin therapy, poor selfefficacy concerning the skills needed for insulin therapy, fear of injections, and a lack of accurate information [11]. These beliefs can be influenced by past experiences, the attitudes of others, participants' perceptions of their diabetes, and their understanding of the disease process [12].…”