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Fear of Injection

Dear members,

One of my female patient with an HbA1c of 9.5% and has received metformin plus SU for the last 2 years. During a discussion of therapeutic options, the patient expresses anxiety about using injectable therapy, but her target HbA1c goal has not been attained with any of the multiple oral regimens she has tried.Once the patient actually experiences an injection in the office, she is much less apprehensive. The idea of a once-weekly GLP-1RA appeals to her more than daily basal insulin.

What is your suggestion? How would you treat this patient?Tq in advance
In this case, it was important to help the patient overcome her fear of injections because adding a third oral agent had not been successful. Although it can sometimes be a challenge, there is value in determining the reasons why patients are anxious about injectable therapy and if there are any potential trade-offs that would make it more attractive (eg, weight loss or the need for only once-weekly administration). An injection trial, even with saline, in the office can sometimes help patients overcome their fear and become more willing to try injectable therapies. Where insulin is required, a strategy to assist patients in overcoming their fear of injections is to start with very low-dose basal insulin. Many patients can accept basal insulin but fear multiple mealtime injections. In such cases, taking a stepwise approach may be helpful, such as starting with just evening mealtime insulin.
I hope it helps you.
god luck 
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