Psychological Insulin Resistance: Key Factors and Intervention

Insulin is a mainstay of treatment in patients with type 2 diabetes mellitus to control blood sugar levels and reduce the risk of diabetes complications, but psychological insulin resistance can delay insulin treatment. Psychological insulin resistance can be defined as a negative attitude and feelings toward insulin treatment experienced by diabetics. Factors influencing psychological insulin resistance include a lack of understanding of diabetic pathophysiology, a negative attitude toward insulin treatment, anxiety about insulin therapy complications and hypoglycemia, distorted beliefs, daily constraints, fear or pain from injections, and discomfort. Various approaches to psychological insulin resistance involve direct demonstration of the insulin administration processes, education regarding diabetic pathophysiology and insulin action, assessment and evaluation of the degree of psychological insulin resistance, patient group training, building correct support systems, and providing contacts (e.g., diabetes center, diabetes nurse educator). The role of healthcare providers is important in reducing patients’ psychological insulin resistance through various interventions.

Psychological Insulin Resistance: Key Factors and Intervention

Insulin is a mainstay of treatment in patients with type 2 diabetes mellitus to control blood sugar levels and reduce the risk of diabetes complications, but psychological insulin resistance can delay insulin treatment. Psychological insulin resistance can be defined as a negative attitude and feelings toward insulin treatment experienced by diabetics. Factors influencing psychological insulin resistance include a lack of understanding of diabetic pathophysiology, a negative attitude toward insulin treatment, anxiety about insulin therapy complications and hypoglycemia, distorted beliefs, daily constraints, fear or pain from injections, and discomfort. Various approaches to psychological insulin resistance involve direct demonstration of the insulin administration processes, education regarding diabetic pathophysiology and insulin action, assessment and evaluation of the degree of psychological insulin resistance, patient group training, building correct support systems, and providing contacts (e.g., diabetes center, diabetes nurse educator). The role of healthcare providers is important in reducing patients’ psychological insulin resistance through various interventions.

Abstract 3775: Education to Reduce Stroke Risk in Prediabetic Patients

Background: Diabetes is a known risk factor for stroke. We sought to assess the reduction of secondary complications of diabetes in stroke patients through an education initiative. We identified prediabetic pts as a group not receiving any instruction in glucose control to prevent diabetes. Methods: At our private, community health center, we introduced a pilot education program for all ischemic stroke and transient ischemic attack patients from March to July 2011. Patients were included if they tolerated oral diet and were placed on the stroke protocol at our center. Patients were identified by a certified dietician and divided into two groups: HbA1c ≤ 6.4% and HbA1c > 6.4%. Patients with an HbA1c of 5.8 -6.4% (prediabetics) were placed on a calorie controlled diet and received diet and activity education from the dietician. Meters were available for them to take home if they desired. Patients with an HbA1c greater than 6.4% received diet and activity education, and also met with the diabetes nurse educator for more in depth education on controlling their diabetes. Our endpoint was to increase the number of patients receiving diabetic education. Results: The program saw 214 patients, and education was provided to 81 prediabetics and 51 diabetics. In the first 4 months of the pilot program, 76% of prediabetics and 71% of diabetics received education. Limitations to education included pts not on stroke protocol so HbA1c was not ordered, difficulty getting orders for calorie controlled diet, and difficulty placing order for Diabetes Educator. By month 5 only 1 pt did not receive education and 5 had not had HbA1c drawn to assess need for education. Conclusion: Education of glucose control strategies for prediabetic and diabetic stroke pts has been effectively initiated. The large population of prediabetic pts has received education to begin to reduce their risk of developing diabetes in the next 3-5 years. Patient feedback has been entirely positive at this time. Future evaluation to determine if pts with prediabetes were able to delay onset of diabetes and reduce development of future stroke would be beneficial.