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From Yemen:

My daughter suffers from insulin injections, and many times refuses to take them until her blood sugar gets high. Some doctors in my country say it would be good to use an insulin pump which is not found in my country. Please help me, and somebody tell me what to do. I am so sad about my daughter.


I don't know what we can or cannot offer. While an insulin pump may be helpful, there will still be "needle sticks!" Glucose monitoring may be even more important with an insulin pump; the insulin pump provides the insulin through a small needle that the patient inserts into the skin (usually the abdomen or hip) - the metal part of the needle is removed leaving behind a small hollow, plastic "needle" through which the insulin flows. This insertion must be moved every two-three days. In addition, there may be times that she will still need to take insulin by shot! For instance, if she has high glucose with ketones, or if the pump malfunctions.

A better approach for now seems would be some type of counseling sessions with your child to understand her issues. There are now very very short insulin injection needs. In the US there "Short" and also "Mini" needles. Are they available to you? They are made by the Becton-Dickinson Company (BD Company).


Additional comments from Dr. Stuart Brink:

An insulin pump will not solve the problem of a teenager who is very angry about having diabetes, doesn't eat properly or test properly or someone who doesn't take their insulin injections. However, you need to sit and keep talking with your daughter. Perhaps you should actually give her shots so that they are not omitted. This will save her life. You should talk with her doctors and nurses and see if they have some ideas, some therapists who can help her understand about diabetes. Also, having your daughter chat with some other teenagers around the world on childrenwithdiabetes website may also be helpful.


Additional comments from Dr. Donough O'Brien:

Needle phobia is quite a common problem especially in people with newly diagnosed diabetes. It can be very distressing to parents not least because it may lead to the often unconscious continuance of manipulatory behaviour after the problem is solved. In ideal conditions, this can be resolved very quickly by an experienced clinical psychologist or Medical Social Worker, but I sense that you will have to depend on other approaches.

One day Inhaled insulin may be the answe, but no system is yet approved. Personally I don't think a pump would be the right way to go either, firstly because it is expensive, and secondly because you really need of a doctor and a nurse educator who are very familiar with pumps to help you get started.

Nevertheless, there are two approaches which you should consider. The first is to screen the needles as much as possible using a device like the FreeStyle or One Touch® Ultra for blood sugar assays and the Inject-Ease® with UltraFine needles to give the insulin. This is a spring loaded injector which has the advantage that the needle can be screened. There are other devices that inject the insulin using air pressure, but again they are expensive and complex to use. Mechanical devices aside, it would also be a great help if you could teach your daughter to relax perhaps by reading a favourite book or telling a story at injection time. Finally, a device much used in this center is to tape a strip of tissue to a child's forehead then have her take a deep breath and slowly breathe out seeing how long she can keep the tissue up.


Original posting 19 Dec 2002
Posted to Blood Tests and Insulin Injections


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