Last month, I delved into some of the common misconceptions and obstacles that may preclude patients from consistently performing self-monitoring of blood glucose (SMBG). Let's now explore some other barriers and see how we and our patients can work together to tackle these challenges.
1. Needle phobia
Needles are ubiquitous in health care—from lab draws, to administering medications, to vaccinations, to checking glucose levels. While technological advances have sharply reduced the amount of blood required, and meters now provide readings in seconds, we still rely on lancets to test, and syringes or pens to administer insulin and GLP-1 receptor agonists.
Understandably, some patients have a disdain for needles. Like you, I work with some whose fear is so marked that they will go to extraordinary lengths to avoid them—a few have declined performing SMBG at all. One remarked, "I'm going to tell you right now, if they try to draw my blood, they either need to hold me down, or knock me out."
One suggestion: show patients with newly diagnosed diabetes (or who are unfamiliar with injections) the needles that are used and then have them inject themselves. This can be very reassuring and may disarm their fear. Some patients may find alternate site testing, such as on their arms, more palatable. (We must advise these individuals that the SMBG readings are less accurate.)
Efforts continue to develop needle-free glucose monitors—from contact lenses to wearable sensors. These have built upon previous unsuccessful attempts, such as the Glucowatch. Touted as a wristwatch that could check readings unobtrusively, this device was plagued by long warm-up times of ~3 hours and, for some, irritation from the electric current to obtain measurements from interstitial fluid.
When I was a fellow, I noticed a patient's log book had a 2-week gap without SMBGs. His explanation? "I was on vacation, so I left my meter and test strips at home." The attending, Steven Edelman, MD, gently advised, "You may go on vacation, but your diabetes never does."
How many times do patients come into your clinic, and admit that they've forgotten to test, or to bring their log books and meters, or both? Or if they do, they may bring spotty records, reflecting a run of the past few days?
With our technological tools, patients have a wide array of options. Apps, phone reminders, and calendar alarms are some examples of prompts to remind patients to test. Since many may forget their meters or log books, but carry their phones virtually everywhere they go, employing their smartphones may be a viable solution.
Trying to prioritize this important task—and ingraining it so that it becomes a natural aspect of the patient's daily life—is key.
3. "It's just another reminder that I have diabetes."
We may not think about this regularly, but patients may want a break from their chronic disease that demands intensive self-management. It can be unrelenting for some, to the point that individuals can suffer diabetes burnout.
Encouraging a shift in perspective—that the SMBG readings are feedback, and not negative reminders on which to render disempowering judgments—can be a positive first step. We can also call upon our colleagues in behavioral medicine to further explore and implement strategies to cope with this chronic disease.
What strategies and insights have you used and learned? Please share.