There was a time when doctors couldn't get anywhere near Sherri Buffington with a needle. "I was deathly afraid of needles," recalls the 44-year-old senior legal secretary from Sicklerville, N.J. "I've been petrified of needles since I was a little kid."
Then in 2004, Buffington was diagnosed with diabetes. When oral medications didn't control her disease, her doctor prescribed an injectable prescription medication along with insulin. Taking these drugs meant she would have to inject herself, sometimes three times a day. "I was apprehensive," she says. "But I felt that if this was going to help me, I'd have to grin and bear it and just do it."
Buffington is far from the only diabetes patient with needle anxiety. More than a third of people with diabetes approach their injections with a sense of dread, and nearly as many feel that injections are the hardest part of managing their condition. The fear can be severe enough to prevent some diabetes patients from taking the medicines they need to control their blood sugar. In fact, one survey found that more than half of patients skipped insulin injections from time to time, often because they feared the pain.
"I always tell patients that having a fear of needles is normal and natural," says Evan Sisson, PharmD, a diabetes educator and assistant professor in the Department of Pharmacotherapy and Outcomes Science at the Virginia Commonwealth University School of Pharmacy. Sisson and other diabetes educators help diabetes patients overcome their fear of shots, so it doesn't become an obstacle to controlling their blood sugar.
Everyone with type 1 diabetes must take insulin injections, because their body doesn't produce this hormone. People with type 2 diabetes take injected insulin or other prescription injectables when pills and lifestyle changes aren't lowering their blood glucose enough.
Why injections? "Injections are the most effective," says Robert R. Henry, MD, professor of medicine in the Division of Endocrinology and Metabolism at the University of California, San Diego and president of Medicine & Science at the American Diabetes Association.
Skipping insulin injections can be extremely dangerous for people with type 1 diabetes. When glucose isn't available for energy, the body starts burning fat instead. That can lead to a state called ketoacidosis, in which acids called ketones build up and poison the body.
With type 2 diabetes, the risk of skipping medications or injections isn't as immediate. But over time, fluctuating blood sugar levels can damage organs like the eyes, kidneys, and heart. Research has found that people who are afraid of their insulin injections have poorly controlled blood sugar and experience more diabetes-related complications. Overcoming needle anxiety can be a key element to preventing these complications.
Needle anxiety is often a learned response. One painful vaccination or shot in childhood can lead to a distrust of needles.
With today's new delivery systems -- which include spring-loaded syringes and pens -- the needle isn't nearly as daunting as many people imagine. "Years ago, when I first started in diabetes, the insulin injections were truly painful and difficult to administer," Henry says. "Now the needles have become so ultra thin and fine, and you almost can't feel them when they go in."
The higher the gauge is, the thinner the needle. The typical needle used to inject insulin is a 31-gauge, which Sisson says is about the width of a tiny speaker wire.
Another element to the fear is misperception -- believing that having to take insulin injections is a sign that you've failed at controlling your diabetes. "In the past when a type 2 diabetic went on insulin, it usually was when things got really bad. So people associate going on insulin with being in really bad shape," Henry says.
Some patients even think that insulin itself causes complications, an idea they've learned from watching friends and relatives with poorly controlled diabetes. Sisson has heard comments like, "If I start insulin, then that means I'm going to go blind, have to go on dialysis, and you're going to have to cut off my legs." In reality, insulin injections can help you control your diabetes so your blood sugar doesn't get high enough to cause these complications.
Sisson and other diabetes educators guide patients through the process of giving an injection step by step to make it easier and less frightening. "We do a demonstration. I do a step -- and then the patient repeats that step with their own insulin syringe," he says. "What patients find is that this isn't as overwhelming as they thought it was."
To make the process easier and less painful, Sisson recommends injecting in the abdomen, where a layer of fat under the skin acts as a cushion. Insulin is also absorbed more quickly from the abdomen than from the arms or legs. Injecting there every time ensures that the insulin is delivered to the bloodstream at a consistent speed.
To minimize discomfort, Sisson advises patients to inject themselves at least two fingers'-length away from their bellybutton and pinch the skin on their stomach. "Just the process of pinching the skin up actually desensitizes the skin so you don't feel it," he says. Sisson also recommends alternating injection spots, because insulin can promote the growth of fat cells. Over time, if you keep injecting yourself in the same spot you could develop a fatty lump in that area.
Buffington has learned which areas on her abdomen cause her the least pain, and she's gotten used to the idea of injecting herself. "Once I did it a few times I realized, this isn't so bad after all," she says. "Most of the time I don't even feel it."
Her fear of diabetes complications also made it easier to overcome her fear of using needles. "I knew I had to do it. I knew how important it was," she says. "All I kept thinking about were the complications that could happen if I don't get this under control. Sticking a little needle in is nothing compared to losing your eyesight."