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Psychological Challenges of Injections

1.1 Children

1 Children have a lower threshold for pain than adults and sometimes find injecting uncomfortable. The Healthcare Professional (HCP) should ask about pain, since many young people with diabetes will not
bring it up spontaneously.
(18, 20)

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2 Younger children may be helped by distraction techniques (as long as they do not involve trickery) or play therapy (e.g. injecting into a stuffed animal) while older children may respond better to Cognitive Behavioural Therapies (CBT) where available. (19)

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3 CBT includes relaxation
training, guided imagery,
graded exposure, active
behavioural rehearsal,
modelling and reinforcement as
well as incentive scheduling.
(19)

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1.2 Adults

1 The HCP should prepare all people with type 2 diabetes for likely future injectable therapy early in the disease pathway, by explaining the natural, progressive nature of the disease, stating that it
includes injectable therapy and making clear that injectable therapy treatment is not a sign of patient failure. (30)

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2 Both the short-term and
long-term advantages of good
glucose management should
be emphasised. Finding the
right combination of therapies
including injectables leading
to good glucose management
should be the goal. (31,32)

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3 Through culturally-appropriate pictures and stories, HCPs should show how injectable therapy could enhance both the duration and quality of life. (31)

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4 HCPs should reflect on their
own perceptions of injectable
therapy and avoid using any
terms which imply that such
therapy is a sign of failure, a
form of punishment or a threat.
(33,34)

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5 Pen devices may have
psychological advantages over
syringes and therefore maybe
more acceptable. (31,35-37)

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