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More than half of the people who need to take insulin to control their diabetes skip an injection now and then, a new study reports.

The researchers found that people with diabetes forgo their insulin injections for a number of reasons, including pain and embarrassment, and that their reasons vary depending on the type of diabetes they have.

“More and more people will be taking insulin, and it’s really important that they learn to manage this powerful medication effectively,” said the study’s lead author, Mark Peyrot, a professor of sociology at Loyola University Maryland and an assistant professor at Johns Hopkins University School of Medicine, both in Baltimore.

About one-fourth of the people who have diabetes — either type 1 or type 2 — take insulin, according to the study, which is published in the February issue of Diabetes Care. Insulin is a hormone that helps regulate blood sugar levels. Without insulin, the body’s cells can’t use sugar to fuel muscles. Insulin can only be taken through injections or an insulin pump.

People with type 1 diabetes, an autoimmune disease, no longer produce insulin on their own and depend on insulin injections to survive. People with type 2 diabetes still have some natural insulin, but they might not have enough or they might be resistant to insulin and require more than their body can provide.

Skipping a necessary insulin dose causes blood sugar levels to rise. And, with persistent high blood sugar, a person’s risk for serious complications, such as blindness and kidney failure, increases.

In their research, Peyrot and his colleagues asked 502 people with diabetes who used insulin to complete an Internet survey.

More than half of those surveyed, 57 percent, said they had intentionally missed an insulin dose, and 20 percent said they regularly skipped insulin injections.

Overall, people were more apt to miss an insulin dose if they were younger, had a lower income, had completed more schooling, had type 2 diabetes, did not follow a healthy diet, were required to take more injections, complained of injection pain, were embarrassed by the need for insulin or thought that the injections interfered with their daily life.

Not adhering to a good diet was the biggest reason that people with type 1 diabetes skipped their insulin dose — something that Peyrot said is not always a negative. That’s because people who get too much insulin are at risk of hypoglycemia (low blood sugar). If they skip a meal because they’re busy, for instance, they may need to skip the insulin dose they were scheduled to take so that their blood sugar levels don’t drop too low.

And, he explained, that’s probably why people with higher education levels were more likely to miss insulin. “It’s possible that it’s not ignorance, that it may be a thoughtful process in this case,” Peyrot said.

Among people with type 2 diabetes, the risk factors associated with insulin omission included age, education, income, pain and embarrassment.

“Some of these factors are modifiable,” Peyrot noted. Using insulin pens with fine-gauge needles, for example, could eliminate some of the pain and embarrassment associated with the injections, he said.

But he also described what he called a “disconnect” between diabetics and their doctors.

“Even when patients ask, providers might not be giving them enough help in overcoming modifiable risk factors,” Peyrot said. “Physicians need to be alert. Patients may tell you their problem rather than ask for help. It’s a hint.”

Katie Weinger, an investigator of behavioral and mental health research at Joslin Diabetes Center in Boston, said that missed insulin doses “is a really important issue in the treatment of diabetes.” She co-authored an accompanying editorial in the journal.

“Diabetes is a very challenging disease,” Weinger said. “You need to have a well-organized, unchaotic life in order to fit diabetes into it smoothly. And, for older people who’ve lived one way for 50 or 60 years, to have to change lifelong habits and take all these medications for high blood pressure, high cholesterol and their heart, and then you put insulin into the mix — it can be overwhelming,” she explained.

“People with diabetes don’t need to give up their quality of life, but they need to find a happy balance between treating and living well with diabetes,” she said. “And, when possible, treatment regimens may need to be simplified.”

SOURCES: Mark Peyrot, Ph.D., professor, sociology, Loyola University Maryland, Baltimore, and assistant professor, medicine, Johns Hopkins University School of Medicine, Baltimore; Katie Weinger, Ed.D., R.N., investigator, Joslin Diabetes Center, and assistant professor, psychiatry, Harvard Medical School, Boston;

Premature aging is striking the brains of people infected with the virus that causes AIDS, new research suggests.

It’s not clear if the virus or the drugs that treat it — or both — are contributing to the aging. But one thing is clear: The blood flow in HIV patients is about the same as in those of uninfected people who are 15 to 20 years older.

“The graying of the AIDS patient community makes this infection’s effects on the brain a significant source of concern,” study author Dr. Beau Ances, an assistant professor of neurology at Washington University in St. Louis, said in a university news release.

“Patients are surviving into their senior years, and a number of them are coming forward to express concerns about problems they’re having with memory and other cognitive functions,” Ances said.

An estimated 14 percent to 18 percent of all AIDS patients in the United States are more than 50 years old, and older people face one of the highest rates of new infections. By 2015, people over the age of 50 may account for more than half of all AIDS patients.

In the study, researchers used MRI scans to study the blood flow in the brains of 26 HIV-infected people and 25 other people who weren’t infected. The average age and education level of the participants were similar.

The researchers found reduced blood flow in the brains of younger HIV-infected patients who were infected recently, not just the older ones.

The study was released online in advance of publication in the Feb. 1 print issue of the Journal of Infectious Diseases.

SOURCE: Washington University in St. Louis, news release.

Birth defects, preterm birth, breast-feeding and eating sushi are a few of the many concerns of pregnant women, according to a new March of Dimes survey.

The poll of about 1,200 mothers found that the leading cause of worry was birth defects (78 percent), followed by concern that stress in their life might harm their baby’s health (74 percent) and wondering whether their baby would be born too soon (71 percent).

About 70 percent said they thought about the pain of childbirth, 55 percent said they worried they wouldn’t get to the hospital on time, 60 percent were concerned they wouldn’t be able to breast-feed successfully, 59 percent wondered about their ability to lose weight after delivery and 59 percent also worried about getting pregnant in the first place. The leading food-related concern was sushi and fish (61 percent).

The findings were presented Dec. 9 at a meeting of the March of Dimes National Communications Advisory Council.

“Women should discuss all their questions with their doctors and should be concerned about their overall health — quit smoking, control their blood pressure, weight and any chronic diseases, such as diabetes — before they become pregnant so they will have a better chance at a healthy pregnancy,” Dr. Diane Ashton, deputy medical director of the March of Dimes, said in a news release.

“The decline in cigarette smoking translates to longer, healthier lives for today’s young people,” said NIDA Director Dr. Nora Volkow. “And while it is disheartening that smokeless tobacco use is up again, the survey is telling us where to focus prevention efforts.”

Marijuana use across the three grades has shown a consistent downward trend since the mid-1990s, however, the decline has stalled, with rates at the same level as five years ago. In the 2009 survey, reported past year marijuana use was about the same as the previous year: 32.8 percent of 12th graders, 26.7 percent of 10th graders, and 11.8 percent of eighth graders. However, marijuana use is still down significantly from its peak in the mid-late 1990s.

The MTF survey also measures teen attitudes about drugs, including perceived harmfulness, perceived availability, and disapproval, which are often harbingers of abuse. For example, the percentage of eighth graders who view occasional marijuana smoking as potentially harmful is down to 44.8 percent, compared to 48.1 percent last year and 57.9 percent in 1991.

“The 2009 Monitoring the Future survey is a warning sign, and the continued erosion in youth attitudes and behavior toward substance abuse should give pause to all parents and policymakers,” said Director Gil Kerlikowske, of the White House Office of National Drug Control Policy. “Considering the troublesome data from other national and local surveys, these latest data confirm that we must redouble our efforts to implement a comprehensive, evidence-based approach to preventing and treating drug use.”

The data on some illicit drugs is encouraging. Past year use of cocaine decreased to 3.4 percent from 4.4 percent in 2008 among 12th graders, and past year use of hallucinogens also fell among high school seniors to 4.7 percent, down from last year’s 5.9 percent rate and significantly lower than its 2001 peak of 9.1 percent.

For the first time this year the survey also measured 12th graders’ use of the hallucinogenic salvia leaf, with 5.7 percent of high school seniors reporting past year use.

Perceived harmfulness of LSD, amphetamines, sedatives/barbiturates, heroin and cocaine have all increased among 12th graders, and the perceived availability of many illicit drugs has dropped considerably. For example, 33.9 percent of 12th graders reported this year that it is easy to get powder cocaine, down from 38.9 percent just a year ago. Similarly, 35.1 percent of 12th graders said ecstasy is easy to obtain, compared to 41.9 percent last year.

The 2009 MTF survey indicates a continuing high rate of non-medical use of prescription drugs and cough syrup among teens. Seven of the top 10 drugs abused by 12th graders in the year prior to the survey were prescribed or, purchased over the counter.

Nearly 1 in 10 high school seniors reported past year non-medical use of Vicodin, and 1 in 20 reported abusing Oxycontin, also a powerful opioid painkiller. Non-medical use of these painkillers has increased among 10th graders in the past five years.

For the first time this year the survey measured the non-medical use of Adderall, a stimulant commonly prescribed to treat ADHD. The survey reported that more than 5 percent of 10th and 12th graders reported non-medical use of the drug in the past year.

In addition, the survey recently started measuring how teens obtain the prescription drugs they took for non-medical use. Nineteen percent of 12th graders reported they got their drugs by a doctor’s prescription, and 8 percent reported buying them from a dealer. However, the vast majority — 66 percent — said they got the drugs from a friend or relative. Of these, 12 percent reported they “took” them; 21 percent reported “buying” them and 33 percent said they were “given” the drugs. Internet purchases do not appear to be a major source of drugs for this age group.

Researchers also report a softening of attitudes in some alcohol measures. Fewer 10th graders viewed weekend binge drinking (five or more drinks once or twice each weekend) as harmful, and fewer high school seniors disapproved of having one or two drinks every day. Alcohol use however, has decreased in the past five years across all three grades.

Overall, 46,097 students from 389 public and private schools in the eighth, 10th, and 12th grades participated in this year’s survey. Since 1975, the MTF survey has measured drug, alcohol, and cigarette use and related attitudes in 12th graders nationwide; eighth and 10th graders were added to the survey in 1991. Survey participants report their drug use behaviors across three time periods: lifetime, past year, and past month. The survey has been conducted since its inception by a team of investigators at the University of Michigan, led by NIDA grantee Dr. Lloyd Johnston. Additional information on the MTF, as well as comments from Dr. Volkow can be found at www.drugabuse.gov.