People with type 2 diabetes facing the reality of starting insulin therapy: factors involved in psychological insulin resistance

Abstract Psychological insulin resistance has drawn increasing attention, due to its multiple implications, to the patient's well‐being, and also to the overall costs of diabetes management. Exploratory studies have emphasised, as main psychological barriers, needle phobia, fear of hypoglycaemia or weight gain, or impaired patient–health care team communication. This study addresses psychological insulin resistance from the qualitative point of view. We analysed 18 people with type 2 diabetes, at the moment of initiating insulin therapy. The methodology was a qualitative one, including phenomenological analysis and content analysis of the semi‐structured interviews. The results show that the most salient contributors to psychological insulin resistance are: the mental representations (patients' personal view of reality) of the reasons for the necessity to start insulin therapy (e.g. incorrect medical decision); the perceived consequences of the treatment (e.g. social rejection); and the factors which contributed to the decision to refuse or accept the treatment (e.g. family, other people with diabetes). Other factors which contribute to the decision regarding insulin therapy are the presence of concomitant diseases and the acute discomfort generated either by hyperglycaemia or by the previous medication. There is an increased need to study this issue in culturally sensitive settings, because of the important role played by the social environment in the adaptation to an intrusive chronic treatment. Copyright © 2004 John Wiley & Sons, Ltd.