Five Strategies to Reduce Psychological Insulin Resistance


People with diabetes may have PIR, where they resist starting on insulin therapy, but pharmacists can use these strategies to help them.

Insulin therapy can be a beneficial and effective strategy to successfully manage diabetes, but one obstacle to its use is psychological insulin resistance (PIR). PIR is resistance and barriers that may hinder a patient’s initiation and adherence to insulin therapy. However, research has found that there are several successful ways that pharmacists and other health-care providers can use to overcome PIR. Here are five:


1. Understand who may be at highest risk for PIR

Before you can reduce PIR, you first need to understand who may be most likely to exhibit it. A 2015 study done in India found that those who had the highest opposition to insulin use were women, people who were based at home, and those with lower levels of education. Other studies done in the United States have found that minorities may also be more at risk for PIR.


2. Understand Obstacles Leading to Resistance

Identifying the concerns or barriers patients may have to insulin therapy is one of the first steps to directly addressing their fears or concerns. One study, led by Nancy A. Allen and published in the Journal of Clinical and Translational Endocrinology, found that the top four barriers reported by patients with type II diabetes were:

  • They wanted to try other options first.

  • They felt taking insulin would mean their diabetes was getting worse.

  • They were scared of needle pain.

  • They were worried about developing low blood glucose levels.

Asking patients directly about their concerns or fears can give pharmacists and other health-care providers an opportunity to intervene and counsel patients.


3. Provide Education

Research has found that one of the common factors driving PIR can be a lack of education. Reducing the impact of PIR can often be as simple as providing patients with the information they need to overcome their barriers and fully understand how insulin can help them better manage their diabetes.

"Their resistance is based on bad information, which providers can help correct," writes Tori Rodriguez, MA, LPC, writing in Endocrinology Advisor.


4. Present Insulin Therapy on a Trial Basis

Patients may be more likely to adopt insulin therapy if it's initially presented as a time-limited trial. In the article in Endocrinology Advisor, William H. Polonsky, PhD, CDE, suggested the idea of what he called an "insulin challenge" or simply asking a patient to try using insulin for a short time, such as 2 to 4 weeks, before making any firm treatment decisions. After the trial, patients can discuss their experience with their health-care professionals, address any challenges or concerns, and determine a long term treatment plan. The strategy may help patients overcome their fears without having to make an initial long-term commitment.


5. Use Demonstrations

Demonstrations provide patients with a visual understanding of what they need to do on their own and may reduce any lingering concerns they have about how to use insulin. In Allen's study of type II diabetes patients, she found that certified diabetes educators (CDEs) could be effective in reducing PIR by doing demonstrations with patients that showed how to give an insulin injection and discussing how these injections could be done when a patient is away from home. Return demonstrations, where patients can demonstrate to the pharmacist or CDE how they inject themselves, are also helpful.

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