Should we Fear Insulin Therapy in the Treatment of Type 2 Diabetes?

David Haslam*
Bariatric Physician, Luton and Dunstable University Hospital NHS Foundation Trust, UK

© 2014 David Haslam.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Watton Place Clinic, 60 High Street, Watton-at-Stone, Hertfordshire SG14 3SY, UK; Tel: +44 (0)1920 830784; Fax: +44 (0)1438 830005; E-mail:


Obesity is the primary risk factor for the development of type 2 diabetes (T2DM) and, as the prevalence of obesity continues to increase, so does the incidence of type 2 diabetes. For most patients with T2DM, the disease will progress beyond the control of lifestyle measures, diet and oral glucose-lowering drugs. In these patients, insulin therapy is ultimately required to lower blood glucose concentrations to acceptable levels. ‘Psychological insulin resistance’ is a major barrier to the initiation of insulin therapy for patients with T2DM and for clinicians treating them. This may have a negative impact on patients’ health and weight, and also the healthcare system due to increased incidence of diabetesrelated complications if HbA1c remains poorly controlled. Ensuring timely and appropriate initiation of insulin therapy requires physicians to recognize patients’ fears and to reassure them. This review explores the concerns behind psychological insulin resistance and how they can potentially be addressed in light of recent developments in the treatment of diabetes.

Keywords: Clinical inertia, hypoglycemia, insulin therapy, psychological insulin resistance, psychosocial, type 2 diabetes.