Make sure to ask what the patient’s thoughts are about starting insulin. This will help to uncover any fears, barriers, or myths which might affect his or her willingness to start and/or comply with the prescribed insulin regimen.

Following are some ideas for how to address various fears or concerns around insulin initiation:

“My diabetes is getting worse” or “This is my fault.”

During the natural course of diabetes it is normal to need more medications to keep blood glucose under control. Keeping your blood glucose as close to your target as possible can lower your chances of getting complications, no matter which medications or insulin you are using. So, insulin doesn’t mean you are becoming ill – it means you are making sure you stay well.

“I am afraid injections will hurt.”

Allow patients to try self-injecting with one of the new shorter, thinner pen needles.  Most patients feel that injecting insulin is actually less painful than checking blood glucose with a lancing device.

“Insulin will cause me to gain weight.”

Reassure the patient that not everyone gains weight when they start on insulin. And remind them that weight gain can be prevented or controlled by following their eating plan, controlling portions and staying physically active. Refer to a dietitian as necessary.

“Insulin is inconvenient and embarrassing.”

Using an insulin pen instead of a syringe and vial can help to address these concerns. Insulin pens are easy to use, convenient, and discreet. 

“Insulin will cause my blood glucose to go dangerously low.”

Many of the newer rapid-acting and long-acting insulins have a very low risk of causing hypoglycemia. Explain the risk of hypoglycemia with the insulins you are prescribing and how to reduce that risk, such as more frequent monitoring and eating a snack around times of higher risk for hypoglycemia (physical activity or delayed or missed meals). 

“Will insulin cause me to go blind or cause me to have complications?”

Patients may recall a relative or friend who started insulin in the setting of a concurrent illness.  Ask the patient about any past experiences they have had with insulin. Reassure them that their situation is different.  Explain that a delay in using insulin is more likely to lead to adverse health events.  Point out that most people report feeling better once they’ve started on insulin and that the chances of diabetes complications occurring are actually reduced.

The Injection Training Tools provided above were independently developed by Joslin Diabetes Center, a nonprofit teaching and research affiliate of Harvard Medical School ( Joslin does not endorse products or services, including those of BD.  About Joslin