Technically, it's known as belonephobia.

In common parlance, that's a fear of needles, and whether someone has a full-blown phobia or not, it presents a big challenge to diabetes health care providers.

"It's a real issue," said Dr. Mary Korytkowski of UPMC's Center for Diabetes and Endocrinology.

"Needle fear is more common than many people realize," she said, "because a lot of patients refuse to tell us they have it. Some people, on the other hand, will outright refuse to go on insulin because it's an injection."

With the spreading epidemic of type 2 diabetes, needle fear may become an increasingly pressing issue, because experts estimate that nearly 60 percent of type 2 patients eventually will need to go on insulin.

While type 2 diabetes is often described as a disease in which people's bodies resist the effects of insulin, it is also a disease of producing too little of the hormone.

By the time most people are diagnosed with the disorder, they already are secreting only half the normal amount of insulin, Dr. Korytkowski said, and that output will decline steadily over the years, even with help from insulin-promoting drugs.

Last year, the U.S. Food and Drug Administration approved the first inhalable form of insulin, called Exubera, by Pfizer Inc., but analysts have said it may be too expensive to easily replace injectable insulin in the foreseeable future.

A 1995 study in the journal Family Practice estimated that up to 10 percent of the population may have a strong enough fear of needles to cause a "vasovagal reflex" -- ringing in the ears, dizziness and fainting -- after getting a shot.

And while some believe that figure is too high, needle fear is still a strong factor in people who resist taking insulin, said Mary Larkin, a registered nurse who heads clinical research at the Massachusetts General Diabetes Center in Boston.

In a study this year, Ms. Larkin and colleagues found that out of 100 people with type 2 diabetes, 33 said they would be unwilling to take insulin if their doctors recommended it, and 60 percent of that group said they were afraid of needles.

But other fears about going on insulin were even stronger, Ms. Larkin said.

Eight out of 10 resistant patients believed their lives would be much less flexible if they had to take regular insulin injections, for instance, and seven out of 10 said going on insulin would be an admission that they had failed to manage their disease properly.

Because type 2 patients usually start out with recommendations for pills and diet and exercise changes, insulin psychologically becomes "almost like the dreaded thing they're trying to avoid," Dr. Korytkowski said.

"I think the medical community may be responsible in part for that fear," she said. "Doctors have used insulin as a threat in the past, saying 'You'll have to go on insulin if you don't take care of yourself.' "

When she encounters a patient nowadays with a strong fear of needles, Dr. Korytkowski said, she will recommend the inhaled insulin or a device like the I-Port, a circular base that only has to be inserted in the skin once every three days, and then can be used as a no-pain port for insulin injections.

Dr. Arnold Slyper, a pediatric endocrinologist in Allentown, Lehigh County, said he prescribes the I-Port more for the convenience of his young patients than to combat their fears.

But he does see children who fear needles, and much of the time, he notices the same reaction in their parents.

One of the best ways to overcome injection fears is to get a child or an adult to quickly try a saline injection with today's syringes, said Karen Harouse-Bell, a diabetes educator at the Latrobe Hospital Excela Health Diabetes Center.

"I think a lot of the fear in some people is based on their past history of seeing relatives who had diabetes and how long the needles used to be. The needles today are much shorter, and if I have people take the saline right away, they're like, 'That didn't hurt at all.' "