Magazine article American Nurse Today

Improving Insulin Adherence in Diabetes Care: By Addressing Patients' Concerns, You Can Help Them Adhere to Insulin Therapy with Less Pain and Anxiety

Magazine article American Nurse Today

Improving Insulin Adherence in Diabetes Care: By Addressing Patients' Concerns, You Can Help Them Adhere to Insulin Therapy with Less Pain and Anxiety

Article excerpt

Despite the benefits of insulin therapy, many people with diabetes don't adhere to treatment. Some avoid insulin therapy or refuse to start it. A recent study found more than a third of the roughly 25 million Americans with diabetes don't take insulin as prescribed and 20% intentionally skip some doses, which can lead to serious health risks.

A study of nurses and physicians found nurses can play a more important role in improving insulin adherence. As nurses, we're well positioned to help patients improve adherence because we play a key part in patient education, spend proportionately more time with patients than do other healthcare providers, and may be more familiar with a patient's health history. Although time constraints may pose a challenge for nurses, if we ask the right questions during outpatient visits and hospital stays and address patient concerns, we can help motivate patients to take control of diabetes and adhere to insulin therapy over the long term.

Using the strategies described in this article, you can help patients better understand and address the challenges of insulin therapy. Patients who receive more comprehensive information about their care are better able to monitor and manage their condition at home.

Tailor the treatment plan

When talking with patients, ask about their lifestyle and concerns about treatment. Then work with the healthcare provider who manages their insulin to develop a treatment plan customized to each patient's needs and abilities. Communication is especially crucial before and during initiation of insulin therapy. But you also should continue to communicate with patients after treatment begins or when it's modified. In many cases, patients don't ask for help or discuss concerns related to self-care while in the hospital, unless their admission is diabetes related. But a hospital stay is a good opportunity to ask about treatment challenges or elicit the patient's questions.

You may want to consider using a motivational interview to encourage patients to identify and resolve concerns about their insulin regimen. The question-and-answer format of the motivational interview helps patients identify, discuss, and address challenges. For example, ask patients to describe insulin benefits and drawbacks and which factors typically cause them to change their injection behavior. Then offer positive reinforcement. Based on their answers, collaborate with the healthcare provider who manages the patient's insulin to make appropriate changes to the treatment plan.

Barriers to adherence

Many patients find insulin therapy complicated, inconvenient, and painful. Some skip insulin doses or stop taking insulin altogether because of a mental barrier, such as fear of needles. To empower them and help them overcome their fears, provide targeted information. For example, various strategies can ease the fear of injection. To teach the proper technique, use an injection pad; have the patient practice inserting the needle without injecting medication. (See Six weeks in their patients' shoes.)

Comforting language can ease patient anxiety, too. When providing injection instructions, avoid such words as "shooting," "spearing," and "stabbing"; these may increase anxiety. Also, inform patients that certain techniques can reduce injection pain. (See How to reduce pain from insulin injection.)

Choosing the proper needle for the patient can reduce both anxiety and injection-site discomfort. Researchers have developed a shorter 4-mm pen needle with a narrow gauge (32G) that has been shown to reduce injection pain and anxiety in insulin delivery, especially in children. These smaller needles are less intimidating and less likely to reach muscle tissue in leaner patients. (In contrast, traditional longer needles commonly are injected into muscle tissue, which increases insulin absorption, negatively affecting both pain and blood glucose control. …

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