Experience of pain from insulin injections and needle‐phobia in young patients with IDDM

We studied attitudes towards insulin injections, needle‐phobia and the experience of pain when using syringes, pens, insulin pumps and in‐dwelling subcutaneous catheters (Insuflon®, Maersk Medical, Lynge, Denmark).

185 children and adolescents with IDDM aged 14.2±4.1 years with a HbA_1c of 6.4±1.4% answered a questionnaire using 10 cm VAS scores (0 cm = hardly noticeable pain/not scared of needles at all, 10 cm=unbearable pain, very scared of needles).

The VAS score of injections (median and quartiles) with syringes was 1.9 (1.1, 3.5) cm, with pens 0.4 (0.0, 1.3) cm, with in‐dwelling catheters 0.4 (0.2, 1.7) cm, when taking a bolus dose with insulin pump 0.0 (0.0, 0.0) cm and when taking a blood glucose test 0.7 (0.1, 2.4) cm. The injection pain declined with increasing age but still several teenagers regarded the injection pain as almost unbearable. Injection pain correlated to HbA_1c (p=0.033), age (p=0.0003), their own (p<0.0001) and their mother's (p=0.032) needle‐phobia (but not father's) but not to diabetes duration or if parents had tried injections or blood glucose testing. Median needle‐phobia score was 0.4 (0.1, 1.4) cm. Overall, 8.3% of the patients, 16.8% of the mothers and 17.7% of the fathers defined themselves as having pronounced needle‐phobia (⩾5 cm). Those using in‐dwelling catheters reported a higher needle‐phobia but their injection pain was in the same low range as for other individuals.

We conclude that, for most patients, the pain when injecting insulin is quite small irrespective of injection mode, but for some it is almost unbearable. Parents' attitudes are important for children's acceptance of injections. Injections through an in‐dwelling injection aid enables children and adolescents to reduce the pain to levels comparable to those who are less needle‐phobic.