The Truth About the Needle.

At a Tour de Cure meeting the other night, someone in the group commented that they had a family member who had lived with Type 2 diabetes for almost 40 years and “thankfully, didn’t need the needle yet.” This was swiftly followed by “he’s terrified of needles, so we thank god he doesn’t need it yet and manages with diet, exercise, and pills.”

The concept of people with Type 2 and their loved ones believing that “the needle” is the ultimate punishment, the end of the road, and the bearer of only bad things to come is not a new one. I’ve dealt with this stereotype for the entire 20 years I’ve had diabetes. What saddens me about these statements is the millions of people with Type 2 diabetes who put off going on an injectable medication such as insulin or a GLP-1 -which could significantly improve their quality of life and slow the progression of their disease and prevent complications-until it’s too late. Lives could be extended for decades, complications a thing of the past, and day-to-day comfort could be improved for literally millions by “the needle.” And yet it remains a threatening specter reserved for only the “worst” diabetics for whom all other options have failed. No wonder people don’t want to take an injection. It is synonymous with failure.

How did we get here? It’s simple really. It’s almost 100 years of misinformation compounded on itself. Here’s the train of miscommunication: Patient X goes to the doctor. Doctor tells patient he has Type 2 diabetes. Patient immediately thinks of grandma, who was “on the needle” in the last years of her life. She was also confined to a wheelchair and had her foot amputated due to complications. Patient associates “needle” with the scary images of his grandma. Patient will now do anything to avoid the needle and promises to change his eating habits. Doctor threatens more medication if he doesn’t. Patient loses 10 pounds by his next visit, but over the course of the next three years, beta cell function declines even though patient maintains his healthy weight (people forget Type 2 is a degenerative disease). Blood sugars climb. Insulin resistance climbs. Patient needs insulin. Patient’s cells are starving to death without it, but patient refuses insulin. Patient takes home insulin sample and leaves it on a shelf in the fridge. The needle,  he believes, is the end of the road. He will end up like grandma, in a wheelchair, footless and miserable. Doctor continues to threaten that if his blood sugars don’t get better, he will need more needles – rapid acting insulin. Patient feels worse every day. He’s tired, lethargic, thirsty all the time, and depressed. His vision has become blurry, and there’s a nagging tingling in his feet. And why? Because the needle is viewed as a punishment in an overwhelming majority of Type 2 treatment regimens.

Imagine a different scenario though, where the doctor in the first year of a Type 2 diabetes diagnosis tells the patient that he has a medication that can help him lose weight and control his blood sugars, and may protect his beta cells from destruction for a while. What if the doctor prescribed a GLP-1 or insulin years earlier in his treatment and was excited about it? What if he assured the patient that although EVERYONE hates needles, this would prolong his life, improve his quality of life, and compliment those healthy changes he was already working so hard to make. Then maybe he could take that first injection in the office, right there with the doctor, and realize that “the needle” isn’t so bad. And that in fact, it might save his life. “The needle” could be the best thing that ever happened to him.

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I feel the need to preface this statement with a disclaimer – don’t think I’m crazy. I want my doc to start me on insulin. I think I’d have better control than with pills, exercise, and diet (not in that order). If he won’t go “all the way” then at least prescribe an insulin pen for spikes which occur when I know the reason why and also when I can’t come up with a reason why. He is balking. I continue to try to have good control with what I know and what I am given. Thanks for this post and for reading my rambling response.

I agree wholeheartedly and I have already made that change with my patients!

Whenever I speak about the possibility of involving “the needle” (usually insulin based therapy) and I see the person balk, I immediately say “I know it doesn’t sound appealing but how amazing is it that with just one medication we can replace something that your body needs more of and help improve your health?”

Invariably when people are presented with something in a positive light versus being told they “failed” oral therapy, diet, and exercise, the outcome is incredibly different!

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