Insulin therapy in Gestational Diabetes, the ouch is more expectation than reality

Insulin therapy in Gestational Diabetes, the ouch is more expectation than reality

People with Type 1 diabetes have to take insulin and although no one likes insulin injections or shots in fact they are not the major irritation in the handling of diabetes.  Certainly when I was caring for people who had islet transplants and  these people had come off insulin, it was the freedom from the regimen of diabetes, the attention to meals, the timing of meals, the monitoring rather than just escaping the insulin injection that was the bigger deal.
None-the-less for someone with Gestational Diabetes (GDM) starting insulin is a big hurdle. I think we as care givers in part create the problem by holding the threat of insulin as something to be used if one “fails on diet” (see Blog of 22nd April 2011).  But, remember, it is one’s pancreas that typically fails. If genetically your pancreas is programmed to make so much insulin and this is not enough for the pregnancy then no amount of dieting that still gives the baby enough nutrients is likely to be successful. Thus insulin is in the cards for some people with GDM.
A new study from Toronto puts insulin injections into perspective.  Pharmacist Shelley Diamond recruited about 360 colleagues and asked them to rate the expected pain of an insulin injection using an insulin pen on a scale of 0 to 10 with 0 being no pain and 10 indicating very severe pain.  They were also asked to rank the anticipated pain of blood glucose testing.   As reported in the Canadian Journal of Diabetes (Vol 35, page 282-286, 2011) the average expected pain for the insulin injection was 4.0 and for the glucose testing 3.6 out of 10.  When participants actually tried an injection as for insulin the pain score most people had was only 1.0 out of 10, much less than anticipated.  Likewise most people scored glucose testing when they actually did it as a 1.0 out of 10, again much less than they expected.  Interestingly, the pain of testing was ranked higher than the pain of the insulin injection.
What does this all mean?  I think the thought of the insulin injection is much worse than the reality. In fact giving insulin causes less discomfort than the glucose testing.  I often say to people starting insulin in pregnancy “Yes, I would prefer not to have to use insulin, there will be a tear the first time you use it, but then it will become easy, it will be less sore than the glucose testing you are doing, the insulin regulates your blood sugar and that is good for the baby.  It is your pancreas that needs help and the insulin you inject does not go into the baby”. In the meantime, I wish health care providers to women with GDM would stop threatening insulin for perceived diet issues, threats are not the way forward and only make insulin more stressful than necessary when it is needed.
ER