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Needle Phobia

Posted on November 18, 2011 | No Comments on Needle Phobia

The serious and sometimes deadly complications of diabetes (e.g., kidney failure, blindness) can often be mitigated through appropriate diet in combination with insulin therapy, which requires regular blood draws to monitor glucose levels. Medical treatments that require regular blood draws are compromised when a patient presents with phobia.

What is needle phobia?
Needle phobia (or phlebophobia) is fear of needles. A small degree of dislike of needles is normal—most people would avoid them if they could. This fear is heightened in people with needle phobia, to the point where they cannot bear the thought of injections. It is a recently defined medical condition that affects at least 10% of the population to a certain degree.

Contrary to other belief, needle phobia is not confined to children, is not an emotion driven or transient phenomenon, and is not a rare condition. The etiology of needle phobia lies in an inherited vasovagal reflex of shock, triggered by needle puncture.

Approximately 80% of patients with needle phobia report strong fear in a first degree relative (i.e., parent, child or sibling).

Whis is this a problem in Diabetes?
In people with diabetes, who need regular injections of insulin, needle phobia can pose a real difficulty. They find themselves in the situation of having to have injections to control their blood sugars and stay healthy, but spending their time dreading the next jab.

Needle phobia is of particular importance in diabetes, as insulin cannot be given in tablet form, as it is broken down in the digestive system. Often, the injections need to be given several times a day.

What are the symptoms of needle phobia?
The symptoms can be very variable. The main feature is anxiety at the thought of injections and avoidance of injections. Symptoms would include a temporary anticipatory tachycardia and hypertension, which on needle insertion turns into bradycardia and hypotension, accompanied by pallor, diaphoresis, tinnitus, syncope or near syncope, and sometimes asystole or death.

What are the techniques of managing patients with needle phobia?
An important role of the diabetes educator is taking the time to sit down with the patient and ask open-ended, non-judgmental questions that help the patient address his or her concerns on needle phobia. Communicating empathy and respect for patients with needle phobia helps them accept their condition without embarrassment. Reassurance about the normality and prevalence of needle fear legitimizes the condition to the patient. Education of this inherited, involuntary condition of needle phobia, and the various methods to counter this condition is a mainstay of a diabetes educator’s armamentarium in dealing with diabetic patients.

While there is no quick and sure route to curing needle phobia, there are ways to lessen the fear of needles in our patients.

Methods to “UNLEARN” the needle phobia reaction in Diabetic patients:

Topical anesthesia at the needle site
Since modern sharp needles produce a needle stick that is usually painless, topical anesthetics are rarely used. The reason for topical anesthesia is to totally eliminate the sensation of being stuck by a needle especially for diabetic patients who will start on glucose monitoring and insulin injection. Application of ice and EMLA (eutectic mixture of local anesthetics) to the injection site for about 15 seconds just prior to the injection can be used in these cases:

  1. Blood Glucose Testing. The value of blood glucose testing lies in helping our patients understand what happens to their blood sugars through the day. It also helps the patient and the diabetes team work out what changes are required. Fortunately thinner lancets and needles are available to minimize the discomfort.
    • Use fresh and thinner lancets in order to reduce the discomfort that comes from piercing the skin.
    • Massage the finger tips to improve blood flow and use the sides of the fingers which has less nerve endings instead of the pad.
  2. Insulin Administration. Needle technology has changed remarkably over the past two decades. Developments in injection technology have produced very fine needles which bear no resemblance to the large needles used for drawing blood which people often visualize when contemplating having an injection. Educators need to reassure patients with the first mention of insulin therapy that needles used today are much finer than what they were in the past, are laser sharpened, and are silicone coated for ease of entry into the skin. Thus the injection process is now one that many patients consider painless.
    • Needles
      • Generally the higher the gauge the thinner the needle is. A 31G needle is therefore thinner than a 28G needle. There are four different gauges being 28G, 29G, 30G and 31G.
      • There are five available lengths 5mm, 6mm, 8mm (5/16″), 12 mm and 12.7 (1/2″) mm.
      • In general more obese individuals would require a longer needle. The short needles do not require you to pick up a fold of skin when injecting.
    • Insulin delivery systems
      • Insulin pens. The use of insulin delivery system like pens can help minimize needle fear and improve patient acceptance and provide accurate dosing than conventional syringe. Pen needles are also sharper than standard insulin needles because they do not go through the insulin vial stopper prior to injection.
      • Insulin pump therapy. Insulin pump therapy is the common name for the technique of continuous subcutaneous insulin infusion (CSII). The user is able to control the amount of insulin released by the device which injects a tiny amount every minute 24 hours of the day into the subcutaneous tissue via a length of plastic tubing with a needle or soft cannula at the end. Once inserted the cannula should not cause any pain.

Are there any options to using needles for insulin injections?
Alternative methods of insulin delivery are currently being explored and available in other countries. One such method is to use a high pressured jet of air to force the insulin through the skin without the use of needles. Other approaches include the use of insulin inhalers.

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