Jewels Doskicz is a registered nurse, freelance writer, patient advocate, health coach, and long-distance cyclist. Jewels is the moderator of Diabetic Connect’s weekly #DCDE Twitter chat, and she and her daughter both live healthfully with type 1 diabetes.

Have you ever had insulin or syringes held over your head as a motivator to get your pre-diabetes or type 2 diabetes under control?

If your answer is yes, you certainly aren't alone.

The psychology behind the threat

People with pre-diabetes and type 2 diabetes can see major improvements with their disease progression if they decide to make the proper lifestyle changes in diet and exercise. Unfortunately, some healthcare providers can take it a step too far, sending intimidating and threatening messages to their patients to try to scare them into action.

Why do pills turn to shots?

Type 2 diabetes is seen as a progressive disease which may necessitate the addition of new drugs as years with the disease pass by. Insulin may eventually be required to keep blood sugars and A1c levels within range.

Adding insulin to your daily care routine when the writing is on the wall is important, and studies show that it may take some prodding from the patient to get their healthcare provider to initiate these much needed changes.

According to Diabetes Health, "Patients' misguided fears about needles, hypoglycemia, and weight gain often lead to reluctance and physician inertia." In fact, a recent survey of physicians' reluctance to start insulin in this population was evidenced by only 50 percent of patients with an A1c above 9.0 being prescribed insulin.

Is this process inevitable?

For some, it may be. The pancreas starts on a downward spiral resulting in a lack of insulin production. That said, with a type 2 diabetes diet, exercise, and weight loss, you can reverse the need to take insulin in many circumstances.

Are we to blame?

According to Andrea Penney, a Joslin Diabetes Center CDE, you aren't to blame. "However," she says, "non adherence to diet and exercise might result in high blood glucose levels that only insulin can control."

To learn more on this topic:
Know Your Insulin Options
Insulin — Tip 1: Why Insulin is Not Just a Last Resort
Taking Insulin Is Not "The End"