Childhood Diabetes and Needle Phobia: Supporting Kids and Parents

Getting a type 1 diabetes mellitus diagnosis is a life-changing event for children and adolescents, as well as their parents or caregivers. Lifestyle changes aside, many pediatric patients struggle with adhering to their insulin therapy regimen due to an irrational fear of needles, or trypanophobia.

This article discusses how to tackle childhood diabetes and needle phobia. And how healthcare professionals, parents, and caregivers can help relieve children’s needle phobia.

Needle phobia is an irrational and persistent fear of needles, formally known as trypanophobia. It interferes with diabetes care by intimidating diabetics into delaying or avoiding blood tests, insulin injections, and other medical procedures.

Some researchers have proposed that humans developed an evolutionary trait thousands of years ago to avoid the dangers of blood loss, infection, and accidents that prickly objects pose.

Unfortunately, despite our modern understanding of medicine minimizing the risks associated with needles, most children retain this phobia and experience needle-related procedural pain—pain and distress caused by needle insertion during medical procedures.

It’s recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in the Blood-Injection-Injury Phobia subcategory.

People who struggle with this heightened fear of needles may exhibit one or more of the following symptoms:

• Dizziness;
• Light-headedness;
• Sweating;
• Shakiness;
• Hyperventilation;
• Nausea;
• Dry heaving;
• A dry mouth;
• Heart palpitations;
• A loss of consciousness.

The symptoms might look slightly different in children since they don’t have the same awareness or control over their impulses. Children with needle phobia might exhibit:

• Excessive, inconsolable crying;
• Temper tantrums;
• Hyperactivity, agitation, and restlessness;
• Physical aggression;
• A tendency to ignore figures of authority, even if they’re usually well-behaved.

Remember that the child might be experiencing normal fear that subsides after they realize they’ll be safe. This is especially true if it’s their first time being subject to medical procedures that involve needles, such as getting their blood drawn for blood glucose tests or getting an insulin injection.

In a 2018 scientific review, it was found that among children aged between 6 and 8 years, 67% reported a fear of needles during immunization. The figures decrease as the children age, with the percentage being 65% in children aged 9 to 12 years and 51% in children aged 13 to 17 years.

Children with trypanophobia will struggle to manage their condition effectively. Besides intimidating them into delaying or avoiding finger sticks or insulin injections, this fear can develop negative associations with diabetes and its treatment.

A study done in 2011 found that children and their mothers who exhibited signs of needle phobia had higher HbA1c results than those of children who reported no needle phobia. HbA1c is a blood test measuring the average glucose level attached to hemoglobin.

Another study from 2018 based on the DISABKIDS self-testing questionnaire found that the quality of life for children with needle phobia and type 1 diabetes was lower, and they also had a poorer coping ability to deal with their perceived pain. This effect is more pronounced if they rely on injections instead of a continuous subcutaneous insulin infusion.

On the other hand, a more recent study published in the Pain Management Nursing Journal in 2021 found that a higher percentage (48–69%) of children and adolescents report a strong negative effect and substantial pain when inserting an insulin pump needle than with insulin injections (35%).

Perceptions of pain and quality of life aside, several other issues can manifest in the children’s personal and social lives, including:

• Difficulty in coping with the emotional and social aspects of diabetes, such as feeling different from children their age and dealing with stigma;
• Difficulty in adhering to dietary and lifestyle recommendations, such as eliminating sweets and remaining active;
• Difficulty transitioning to more intensive or advanced treatment options.

Unfortunately, parents and caregivers can often be the cause of a fear of needles to begin with. Many parents discuss their own fear of needle-related procedures in front of their young children, priming them to become apprehensive of needles even before they encounter one in real life.

To prevent unnecessary fear before any needle procedure, parents and caregivers should sit their child down and explain what will happen in simple terms. If the child is only old enough to understand words like “pinch” or “poke,” they should be used instead of medical terms like “needle” or “inject.”

Distraction is a strategy that adult patients with needle phobia swear by. The simple act of not looking at the needle or the blood drawn for sugar tests can make the process less terrifying.

Distracting the little ones from needle pain is much easier. Watching TV or a video on a smartphone or tablet also works. For younger children, having a toy near them, like a stuffed animal or a doll, can also soothe them.

Suppose your child tends to ignore all instructions and bolt to the door or throw a tantrum and refuse to cooperate. In that case, it pays to try the previous emotional coping strategies before resorting to restraining them. Children are likely to respond better to their diabetes treatment if they’re not physically forced to sit through it.

Healthcare professionals specializing in pediatric diabetes care have an immense responsibility when it comes to preventing needle phobia and accommodating patients who have it.

The onset of needle phobia was calculated to be around 5.5 years old. So when it comes to prevention, it’s imperative to manage the natural fear of needles that younger children experience with tact.

Pediatric nursing staff are accustomed to using a calm, reassuring voice, taking the time to explain the procedure, and not resorting to the use of restraining force, which can reduce the number of cases that develop the phobia.

For children and young adults who already have the phobia, there are ways to make needle procedures less daunting.

Discussing pain coping strategies with the patient, using lancets instead of needles for blood glucose testing, and explaining distraction methods can all reduce needle-related fear.

The children should also be encouraged to participate in the needle procedure; they can choose the injection site, hold the syringe, or press the plunger to feel more in control of their bodies and treatment.

Different pain relief methods can also be beneficial, like numbing creams or sprays before the injection and cold compresses after. For older children and adolescents, breathing exercises can also help distract from the needle

Needle-free injectors can also effectively eliminate the pain and fear associated with using needles in medical procedures.

It’s best to train the person who will inject the insulin before they take on the task if multiple daily injections are necessary to manage diabetes.

While there isn’t a single best or beginner-friendly site for everyone, the abdomen, thigh, arm, and buttocks are all potential sites to practice on. Alternatively, using an orange to practice the angle and technique of the injection is bound to prevent unwanted needlestick injuries and the pain of hitting a nerve.

Another important role only doctors can fulfill is prescribing new technologies that make diabetes care-related tasks, like injecting and self-testing, easier for the patient. This is crucial since most insurance providers require a prescription to offer full or partial coverage of new diabetes care devices.

Instead of a regular glucometer, a continuous glucose monitoring device (CGM) could reduce the need for finger pricks. This makes the patient and their caregivers more aware of their blood glucose levels to offer better glycemic control and avoid the associated risks of hyper or hypoglycemia.

A needle-free jet injector could also be the answer for patients who don’t adhere to their diabetes care routine because they are afraid of self-injection using a conventional pen.

Using a needle-free injector requires less active participation from the patient. Moreover, the absence of a sharp needle takes away the intense fear of the injection process.

One of the more valuable ways a parent can support their child who experiences needle-related anxiety or phobia is to ask their healthcare provider if they can switch to a needle-free insulin delivery method.

Comprehensive needle-free systems, such as InsuJet, allow the child to be more comfortable while self-injecting their insulin, making them more likely to adhere to their diabetes treatment regimen.

InsuJet has a state-of-the-art design that combines the portability and ease of use of a conventional insulin pen with the comfort and discretion of a needle-free jet injector.

The child, parent, or caregiver can insert the number of units using the dedicated control. Then, they can remove the cap, undo the safety lock, and let the spring-loaded mechanism deliver the insulin injection within a fraction of a second.

With the added feature of the comfort ring, insulin delivery has a less traumatic impact on the injection site. This allows your child better control over their treatment and, eventually, more independence.

You can use InsuJet with any commercially available insulin pen cartridges thanks to the 3 ml or 10 ml adaptors. They’re available with the Starter Pack and are also sold separately.

Pediatric diabetes patients who rely on insulin therapy to keep their condition under control are just as vulnerable to needle phobia as other children, if not more. This means they can struggle to monitor their blood glucose levels and self-inject life-saving insulin, which can put their health and safety at risk.

That said, it is possible to help children with this phobia conquer their fear, or at least not let it stop them from receiving the medical care they need for metabolic control.

Parents and healthcare professionals should work together to enhance the emotional coping ability of the child to prevent an enduring needle phobia, and one of the best ways to do that is by investing in InsuJet’s needle-free insulin delivery system.