Dispelling Concerns: Overcoming Insulin Therapy Barriers for Elderly Diabetics

1. Fear of Insulin Addiction

Insulin dependence is a prevalent concern that prompts some elderly diabetics to resist or discontinue insulin treatment without medical guidance. Given the presence of complications and the necessity of long-term insulin injections for many elderly diabetics, both patients and their families often perceive insulin as addictive and strive to avoid it.

However, insulin secretion is naturally regulated by blood glucose levels. For individuals with diabetes who lack sufficient endogenous insulin, supplementary insulin is crucial to maintain normal or near-normal blood sugar levels. Elevated blood glucose also stimulates the pancreatic beta cells to secrete insulin; thus, long-term insulin use does not lead to dependence. Diabetic patients must understand that insulin is an essential hormone for human survival, and exogenous supplementation is a physiological, highly effective, and minimally side-effect-prone method to treat diabetes. Insulin is undoubtedly not a harmful or unnecessary "drug."

2. Anxiety over Hypoglycemia

Elderly diabetics, with an impaired blood glucose regulation mechanism, frequently experience hypoglycemia during treatment. This fear often deters them from insulin use.

To approach hypoglycemia rationally:

(1) Hypoglycemic episodes are inherent to tight glucose control. The lower threshold of normal blood sugar marks the critical point for hypoglycemia. Diabetics striving for ideal glucose control standards will inevitably encounter mild to moderate hypoglycemic reactions due to various and unpredictable factors influencing blood sugar fluctuations.

(2) Hypoglycemia is preventable and treatable, whereas inadequate glucose control can result in irreversible chronic complications.

(3) Proper management of hypoglycemia, by early intervention and allowing reversibly damaged pancreatic beta cells to recover, can boost endogenous insulin reserves, partially restore blood glucose homeostasis, and ultimately decrease future hypoglycemic incidents.

3. Concerns over Injection Inconvenience and Errors

Impaired vision and memory make it challenging for elderly diabetics to accurately determine insulin dosage, formulation, extraction scale, and administration sequence, fearing incorrect, excessive, or insufficient usage.

For visually impaired elderly patients, family members can be trained to administer insulin injections, serving as invaluable allies in diabetes management. Both patients and caregivers should adhere to the "Three Accuracies and One Attention" principle when injecting insulin: accurate timing, accurate dosage, accurate formulation, and attention to injection sites. Abdominal subcutaneous injection is preferred for older patients, those with thick abdominal fat, poor vision, or using short-acting insulin. For medium- and long-acting insulin, alternate injection sites in the buttocks periodically to prevent local malabsorption from prolonged use at a single location.

4. Social Constraints

Regular insulin injections may discourage elderly diabetics from engaging in outdoor activities, travel, social visits, or events. Patients should be reassured that, with appropriate adjustments, insulin therapy need not hinder their active lifestyles. Using premixed insulin can reduce injection frequency and extend rest intervals, making travel, visiting, and social participation more convenient.

5. Financial Burden

The cost of insulin, alongside oral hypoglycemics, lipid-lowering, and antihypertensive medications, can be substantial for diabetics. Yet, the UK Prospective Diabetes Study demonstrates that intensive insulin therapy can significantly reduce complication rates and effectively manage blood glucose. Investing in optimal diabetes care is a long-term investment in health and an effective strategy to minimize overall healthcare costs. By addressing these concerns and adopting tailored strategies, elderly diabetics can confidently embrace insulin therapy and reap its benefits for improved disease management and quality of life.