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Umm what now
July 1, 2014 5:00 PM   Subscribe

Hubby was diagnosed with diabetes last week during pre-surgery check up. He had the surgery today and that was fine, but it's been sprung on him rather suddenly that this means injections 4 times a day. Most people grin and bear it but hubby has a HUGE injection phobia going back to childhood. He's in a lot of distress. I don't know what to do to help my hubby.

Both his surgeon and primary care doc promised last week that the Insulin could go in the IV but deferred to the hospital pharmacist who says no. We made the nurse go back and beg one more time but it's not looking good. The "good" post-surgery drugs (morphine, Valium) did nothing to stop the bitter weeping. I don't know what to do. I don't want to pull a "Dr. Google" but there's got to be a way to minimize his suffering?
posted by bleep to Health & Fitness (23 answers total)
 
Can you give us some more information?

First off, was his surgery for something related?

What kind of diabetes was he diagnosed with, Type 1 or Type 2? Why does he immediately have to go on insulin? Usually doctors give patients meds and diet/exercise changes first.
posted by radioamy at 5:02 PM on July 1 [2 favorites]


I would ask the surgeon and/or primary care doc to refer him to a psychiatrist immediately, or a hospital social worker. There are effective treatments for these kinds of phobias. He doesn't have to do this alone.

The other thing is that one of the biggest treatments for a phobia is--you guessed it--exposure therapy. So quite honestly, he will probably stop being scared of it after a while. That said, he should have significant help from one or more mental health professionals.

Morphine and valium (and surgical anaesthesia) can all contribute to a lowered mood.
posted by the young rope-rider at 5:09 PM on July 1 [8 favorites]


I'm not sure if you are seeking advice about therapy (which your husband may find helpful), or diabetes care, but I can offer some of the latter.

There are a few alternatives for the injection-phobic who are insulin-dependent. One possibility is an insulin pump. This will still require a single sub-dermal insertion every few days, but it doesn't involve a syringe, so hopefully that would be less traumatic. Insulin pens might also be less intimidating.

Another possibility is inhalable insulin, which was just approved by the FDA days ago. I'm not sure when it will be available on the market, though.
posted by Conrad Cornelius o'Donald o'Dell at 5:13 PM on July 1 [1 favorite]


In my local hospitals, post-surgical patients get regular blood glucose checks and insulin injections if needed. It's fairly standard, even for diabetics who control their disease with diet alone, diabetics who only take oral medicine, etc. If your husband is newly diagnosed with diabetes, there is a good chance he won't have to continue using insulin once he is discharged home.

I agree with the up thread suggestion that he look into therapy for this issue going forward. It's common for diabetics to eventually start needing one or more types of insulin to maintain good control, so injections are something that your husband will need to get more comfortable with. Insulin injections are subcutaneous and the needles used are so fine that if he looked away he might not even feel the injection, honest.
posted by little mouth at 5:17 PM on July 1


Just to clarify: it sounds to me like the immediate concern is the injections that he is going to be receiving while recovering in the hospital for the next few days? Definitely continue raising a fuss about this with his nurses, doctors, and whoever else you need to complain to in order to get either psychiatric help or another dosage method.

Have you been assigned a hospital case worker or social worker or patient advocate? Can you ask for one?
posted by muddgirl at 5:18 PM on July 1 [1 favorite]


You might want to look into online support groups for diabetes and diabetes caregivers. I cannot vouch for quality but this one looks like a good starting point.

There is also an online chat and a phone number for diabetes support offered by the American Diabetes Association that you can call offered by diabetes.org. They also have local offices and you might want to stop by and talk to someone there.

An insulin pump might be a better option for him. You don't have to do individual injections with a pump. Talk to your doctor about this.

Good luck and take care of yourself while this is going on. Eat well, get sleep, and make sure you take care of you, too.
posted by sockermom at 5:24 PM on July 1 [1 favorite]


I don't know how to assuage his fears, but I can tell you that I had to deliver sub-cutaneous injections about 14-16 times (for a different diagnosis), and he can do it.

The things that helped me (YMMV):

1) I would get extremely anxious before my injection time: so I watched something I found absorbing yet somewhat light: Oprah. As silly as it sounds, watching a TV show helped me as The Hour of Injection approached.

2) SUPER FUN TREAT afterwards: obviously for a diabetic you want to use a healthy treat if it's oral, but you get the idea. I used to make lattes or have a bit of gum.

3) For some reason I tried to do it slowly one time. MISTAKE. It made me feel quesy and squeamish. My intructions (again - your mileage may vary) was to quickly insert the needle in a short, stabbing motion (holding the needle firmly). I learned not to do my own thing but to follow the advice and instructions TO THE LETTER, including rotating around my abdomen.

I only hit a vein or something and had a tiny dot of blood ONCE, and I simply put some tissue on it and it stopped bleeding almost immediately.

He can do this! It does get better, each time he does this he gains INJECTION EXPERIENCE POINTS. After a while he will have INJECTION ACHIEVEMENT UNLOCKED. :)

I never liked administering the injection, but I was able to deal with it. He can, too.
posted by joseph conrad is fully awesome at 5:30 PM on July 1 [5 favorites]


(I forgot to mention: I tried to be detached and like a robot when I did it, like, "Oh I administer this now, it is a task to do, hum-dee-dum". It did not help me to over-think it or build it up too much in my mind. Hard to practice, I know.)
posted by joseph conrad is fully awesome at 5:34 PM on July 1


Thanks for all your help as per usual you guys are awesome.
posted by bleep at 5:36 PM on July 1 [1 favorite]


Find someone who will let him try out the insulin pump for sure.

From what I understand, this is a lot less needle sticking (i.e. once every few days or something). If his doctor gives him conditions (managing his blood sugar flawlessly while using needles multiple times per day, for example) for being allowed to have an insulin pump (should he decide he wants one), find a different doctor. That is just mean and it is not necessary.

A pump makes managing sugar/insulin levels much easier; this is why they hand them over without a word to parents of little kids who have diabetes.

Needle phobia falls under the "quality of life is declining" phrase and the "can't function normally" phrase that will get some Results from a good doctor.

Advocate for him loudly. The louder you are, the more likely they are to do whatever it takes to make you shut up. BE LOUD.
posted by AllieTessKipp at 5:40 PM on July 1 [3 favorites]


Yes, I had to give myself daily injections for several years as a young teenager (13-16) and what joseph conrad is fully awesome says about following the injection instructions is spot-on. I used to have a needle phobia but it went away after giving myself a shot every day for three years. Also, the medication really helped me, and if he starts feeling better and he realizes that it is from the shots that will really help, too. My shots were really important and really enhanced my quality of life.

Practicing detachment works really well too. I pretended I was injecting someone else. I also learned how to do it using an orange, which was helpful and also kind of fun.

Yes, AllieTessKipp is right: use the phrase "quality of life" - say "delivering four injections a day is really going to diminish his quality of life; is an insulin pump an option?"
posted by sockermom at 5:41 PM on July 1


If he is going to be on insulin once he is out of the hospital I'd suggest you look into insulin pens, heck they might even have them in the hospital. While they are still an injection they look nothing like the traditional syringe like they use in hospitals and the needles are super fine and sharp. Really it just looks like holding a marker up to your skin with a needle barely half an inch long and so think it's hard to see.

It is not the cheapest option as the insulin comes in cartridges and there is a little waste, but my mother who has had to have 4 injections a day since her 20's and is now 75 thinks they are the greatest thing since sliced bread. She still remembers have to boil up glass syringes to sterilize them and reusing needles until they were too blunt to go through her skin.

Also get him to work on getting used to pricking his finger, even if he is lucky enough to end up not needing injections later on he is going to have to monitor his own blood levels. You can get a range of nifty devices that pretty much hide the point so they look nothing like a needle going in.

Again not sure from your question if injections are going to be a full time part of his life now, or just while in hospital but in case I know everyone here is saying that the pumps will give him better quality of life, but my mother has been offered them several times and they are a lot more annoyance and faffing than a quick shot. To quote my mother who I just told about your question "Put him on a pump for a few months and he'll be asking for the shots". She has a high pain tolerance and no needle phobia though and I think she likes the feeling of control of doing her own shots when and as she needs them instead of eating to a timer she's plugged into. Not meaning to sound like I am criticizing this an an option, if a pump makes it easier for your husband that is great, just giving you another POV.

My mother did say that she used to cry when she had to inject herself at first too, but not from the pain of the shot, every time she had to have the injection it reminded her that she would have this for the rest of her life, which at the time was a bit of a grey area as no one was sure how long she would live. While I am sure the phobia is the main problem you might want to consider that post surgery he's not feeling very strong and it probably all feels very overwhelming to him.
posted by wwax at 6:10 PM on July 1 [1 favorite]


Well inhalable insulin sounds exciting.

I didn't really have too much of a needle phobia, although I'm a bit squeamish about medical stuff in general—but if it's pain that your husband is worried about, I have found that injections using my insulin pens are actually less painful than pricking my finger to use a glucose meter is. With the pens at least it's delivered through incredibly fine needles, much smaller gauge than what's used to take blood samples.

Also, if this is type II diabetes that's at all related to being overweight and he's had trouble losing weight, I really have to recommend a low-carb Atkins-type diet. I haven't even done very well staying away from carbs and I've had fabulous success both in losing weight after being overweight my entire life, reducing my A1c (glucose-related lab test) levels, and consequently reducing my insulin dosage.

If I'd known that I might be able to safely lose weight by eating more cheese and more Indian dishes (both vegetarian and meat-based, just not the potatoes or rice) I probably would never have developed diabetes. My assumption was always that there had to be some catch with an Atkins-type diet but as of my most recent checkup my triglycerides, cholesterol, and blood pressure have all gone down despite the fact that I've been consuming much more fat and more foods with added salt. (I should note, though, that I do almost all my own cooking these days, so I'm very aggressively in control of exactly what I eat; but for example I eat as much fast food now as I have during most of my life.)
posted by XMLicious at 6:30 PM on July 1 [2 favorites]


Also btw treats do not necessarily have to be healthy if you're diabetic; sweets produced with sugar alcohol (usually labeled "sugar free", but you have to check the nutritional information and ingredients, since something could be sugar free and sweetened with an icky artificial sweetener instead) have all the same carbs and calories something with regular sugar would, and taste exactly the same to me, but have a much less spiky effect on my blood glucose than sugar, stretched out over a longer time frame.

The catch is that for most people, if you eat sugar alcohol in any large quantity you get the sort of symptoms a lactose-intolerant person might get from consuming lactose and spend lots of time in the bathroom, so you usually can't risk more than a few pieces of candy. And beware things that substitute sugar alcohol for sugar but contain other normal carbs, like most "sugar free" cookies, which will elevate your glucose levels.
posted by XMLicious at 6:51 PM on July 1


I suspect the drs will make him wait a bit for an insulin pump (a godsend!!), but not for a "pen". It's not going to fully assuage his needle fears, but it is way way WAY better. Much more like the poker he has to use on his fingers to check his blood sugar.
posted by kestrel251 at 7:24 PM on July 1


I have needle phobia/PTSD. I underwent hypnotherapy for it as a tween as a condition of hospital admission for elective surgery. It didn't solve my problems completely, but I no longer have the sorts of severe negative reactions (panic attacks, freakouts that result in hitting nurses) that characterized my childhood reactions to shots.

If your husband's injection phobia is like mine, I strongly suggest looking into therapy.
posted by immlass at 8:13 PM on July 1


Argh, my computer deleted my reply. Here's the summary:

When I found out (at 26) that I'd have to have a blood test as part of my application for a spousal visa I sat in the back of my bedroom closet and sobbed. Your husband is definitely not the only one. (I also had had exactly one shot in the previous 20 years.)

Anyway, between some ongoing health issues that took awhile to diagnose and now being pregnant, I can attest to the fact that he absolutely CAN work through this. I can also attest that working through it and "getting over it" and not having to put (SO MUCH) energy into the fear + avoidence + alternatives etc. is TOTALLY worth it. It's such a relief. For me, it was just repeated exposure due to some health problems and now due to being pregnant.

Two things that helped:
Meditation, and sort of meditating through the whole thing. An injection only takes about 10 seconds... you can survive anything for 10 seconds (deep breath!)
STEMMING. I wiggle my toes, but there's heaps of little toys and things they make especially for this purpose. Having something to fiddle with as a mental and physical disctraction is amazing.

(Oh, and bribery. You can move from the tiny one after each event, to a slightly larger one weekly, etc. I've seriously come thisclose to making myself a star chart with stickers. I'm 32.)

And yes - absolutely lobby for therapy ASAP.
posted by jrobin276 at 8:16 PM on July 1 [1 favorite]


I've read/heard a bunch of good stuff about this little gadget that blocks pain before injections. It is cold and vibrates which apparently numbs the injection area for a couple minutes, long enough that you can't feel the shot. If I remember right, it was invented specifically for a child with needle/injection phobia. I haven't used it myself but worth a shot maybe?
posted by Snarl Furillo at 9:23 PM on July 1


My dentist uses a tiny vibrator before injections.
posted by brujita at 10:21 PM on July 1 [1 favorite]


Not specific to diabetes/insulin, but I was needle-phobic to the point of panic attacks (and sometimes violence against the person with the needle) when I was younger. Best piece of advice I ever got was from and awesome phlebotomist, back when I was getting regular blood draws for med-related monitoring: wiggle your toes.

It sounds kinda stupid, and I scoffed at her at the time, but I tried it anyway. It worked magic. I still cry, I still have to watch my breathing, I still get that numb, pre-panic-attack feeling - but there's something about the focus it takes to wiggle my toes that gets me through the actual moment of the injection or the blood draw.
posted by okayokayigive at 6:26 AM on July 2 [2 favorites]


More about Afrezza (the inhalable insulin):
There is no firm launch timeline yet, though in the past, the company expected to launch Afrezza within six months of FDA approval.
Much more at the link.
posted by Conrad Cornelius o'Donald o'Dell at 8:43 AM on July 2


He should probably know that the needles used for insulin injections these days are very fine--probably finer than other needles that he's encountered for blood draws or injected meds like vaccines. My spouse is diabetic and she says those needles aren't really difficult to deal with.
posted by dlugoczaj at 12:06 PM on July 2 [1 favorite]


(It's also easier to inject insulin because it's just a subcutaneous jab--i.e., he doesn't have to find a vein and shoot for it as he would if he were giving blood or something like that, which makes the process a lot more complicated and slows it down. A quick jab in the torso or thigh is all he should need, and he can move it around so he isn't wearing out a specific area, which is more painful.)
posted by dlugoczaj at 12:09 PM on July 2 [1 favorite]


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