This content originally appeared on diaTribe. Republished with permission.

By Susannah Chen

From blood tests to self-injections and technology, needles are an inescapable part of diabetes care. If you have a fear of needles, there are several anxiety management strategies you can use to overcome this fear.

Carol Gee recalls shuddering when her mother was diagnosed with diabetes late in life and put on insulin. “I couldn’t imagine ever having to do that,” she said, referring to her lifelong fear of needles.

Fifty years later, Gee herself landed in the hospital with a diagnosis of type 2 diabetes. “I was hospitalized with blood glucose so high that for four days the nurses kept saying that I was lucky to not be in a coma or worse,” she recalled. “I was told I would need insulin. I was frightened to death.”

Gee, an Atlanta-based author who has now lived with type 2 diabetes for 14 years, has since learned to manage her fear of using needles. For her and so many others, it was a necessity. Because diabetes requires constant monitoring of blood glucose, for both children and adults with the disease, this means that facing sharp objects like syringes, lancets, injection pens, infusion sets, and continuous glucose monitors (CGM) are an unavoidable part of life, as are regular blood tests.

By addressing some of the psychological roadblocks around self-injection and self-testing, and with the help of anxiety management strategies, you can manage and even overcome a fear of needles.

Know that a fear of needles is relatively common

If you live with a fear of needles, syringes, and medical injections, it may be helpful to realize that you’re far from alone. As many as 2 in 3 children struggle with some level of either needle fear (anxiety about pain immediately prior to facing a needle) or trypanophobia (a fear of needles that is severe enough to impact quality of life).

But a fear of needles can affect anyone, regardless of age, and it often also carries from childhood into adulthood. So, if you’re feeling embarrassed about a fear of needles, remember that as many as 1 in 4 adults around you struggles with the same thing.

Remind yourself of your ‘why’

It’s helpful to start by remembering why you’re dealing with the quick, temporary discomfort in the first place.

“Insulin needles are usually only a half-inch long, and injections last for a few seconds,” said Angie Victorio, an Orange County-based registered nurse, diabetes educator and founder of DiaBettr.com, a site focused on helping people manage type 2 diabetes. “It’s not as invasive as other injections, and [it’s] something you do in the comfort of your own home.”

Skipping injectable medications or blood glucose checks may have a negative impact on blood sugar control and increase the risk of diabetes-related complications.

Victorio advises reminding yourself of why the test you’re about to administer or the injection you’re about to take is essential and the ways in which this treatment will make your body stronger. “These needles and injections are all part of improving health,” she added.

Gee, for one, managed to get over the initial hurdle of insulin injections by reminding herself of her resilience. “Any time I’ve had to do something– military basic training, completing college, flying – I [have told] myself that I could do it,” she said.

Once she overcame the first injection without passing out, she told herself she could continue to administer insulin.

“Although I still hate injecting myself, I realized not taking insulin had serious side effects, like amputations and a shortened life span,” she said. “I still hate needles – I cringe at people injecting themselves in movies – but I want to live, and if injecting myself will help this, I’ll stick myself.”

Identify what precisely you’re afraid of

Determining the exact reason why you feel anxious around needles can help to better address the issue. Ask yourself: What specific aspect of the experience causes fear? Some possible reasons include:

Worries that the pain of a needle will be unmanageable
Physical hypersensitivity to the pain, which can be inherited
A traumatic previous experience, such as experiencing multiple attempts to draw blood
Fear of an injection-related complication such as bleeding, bruising, or injection
An association between needles and a negative experience, such as spending time in a hospital or being in poor health

Determining the root of the fear allows you to acknowledge and address concerns more directly.

The Anxiety & Depression Association of America recommends jotting your fearful thoughts down on paper in one column (such as “I’m afraid I’m going to faint”), and then addressing whether or not they are supported by facts in another (“if I’m worried I’m going to faint, I can always ask to lie down first”).

Be upfront about your fear with healthcare professionals

If your healthcare provider has either recently recommended blood sugar monitoring or injectable medications, be honest with them about the fact that you are feeling nervous.

“Your care provider should definitely know if there’s anything that could affect your ability to take medication,” Victorio said.

Let any medical professionals who are treating you know if you are feeling nervous, either about blood sugar monitoring requirements, injectable medications, or laboratory blood tests. They can work with you to develop a tailored plan that meets your preferences and helps manage your fears.

This might include offering alternative medications that aren’t injectable, finding ways to decrease the number of needle procedures in your treatment, or answering any questions you might have to put you more at ease.

“It’s helpful to share specific concerns you have with needles so your provider can help find different options,” Victorio said, adding as an example: “If the person simply won’t use needles for any reason, the provider could look at other ways to take insulin without needles, including through an insulin pump or even an inhaler.”

Even a refresher on injections could help. One global study suggests that simply asking a healthcare professional to demonstrate the injection process can help many patients better manage a fear of needles.

Try breathwork and other calming techniques

Victorio also suggests a number of self-calming techniques, from practicing muscle relaxation techniques to meditation regularly to reduce overall anxiety. “Playing calming or enjoyable music to distract from the injection and taking walks before injections” can also be effective, she added.

Practicing certain breathing techniques can help you manage anxiety around needles, too. The Cleveland Clinic recommends those with trypanophobia try a deep breathing technique of counting to four on each inhale and exhale.

Another self-injection breathing technique involves taking deep breaths before the injection and exhaling forcefully during the injection.

Consider help from a pro

If your fear continues to impede your ability to take care of your health, consider seeking the advice of a professional.

One behavioral technique to help you conquer anxiety around needles is exposure therapy, where a licensed therapist can work with you to gradually acclimate to needles so that they become less intimidating over time.

If other measures have proven ineffective, a psychiatrist may prescribe sedative or anti-anxiety medications to help relax your body and brain.

Regardless of the circumstances surrounding your concerns, it’s helpful to remember that by conquering your fears, you’re taking steps to better your overall well-being.

“When [a person with diabetes] chooses to take their medication or fingersticks, they’re actually taking control of their health and should feel good about that,” Victorio said. “It can serve as a daily reminder that they in fact can take control.”