Considerations:
- Your school nurse or other licensed health care professional must review the procedure with you to ensure that you have the skills to perform insulin administration competently.
- Because insulin doses depend on blood sugar, food intake and activity levels, it is critical to give the exact dose ordered.
- It is best practice to have a second person double check the dose you dial in on the insulin pen before administering it to be sure it is correct, check with your school nurse or the student’s healthcare provider if you are unsure if a double check is needed.
- Insulin is administered subcutaneously. This is the tissue between the skin and muscle mass, typically known as the fat layer.
- Insulin is best absorbed when injection sites are rotated. The common injection sites are abdomen, upper arm, upper buttock, and outer thigh.
- Be sure to check with the student or the student’s parents to discuss preferred injection sites and rotation of sites.
- The insulin pen contains a clear vial with insulin inside the cartridge and a clear protective cap with a cover that protects the needle.
- If the student is old enough and has been trained in their diabetic care, encourage them to assist to help the student learn self-care skills, according to the child’s care plan and the school nurse’s direction.
- Remember to keep health care information confidential.
Medication storage considerations:
- Check the drug manufacturer’s instructions on how long an insulin pen can be used once it is opened.
- Most opened insulin pens can be used for either 10, 14, or 28 days, but there are some pens that can be used for 42 or 56 days, depending upon the type of insulin in the pen.
Supplies:
- Insulin pen
- Gloves
- Alcohol Swabs
- Unopened needle
- Insulin cartridge (may be inside insulin pen)
- Sharps disposal container
- Healthcare provider’s orders
- Diabetes Medical Management Plan
- Student’s Individualized Healthcare Plan (IHCP)
- Parent/Guardian authorization form
Procedure:
- Explain the procedure to the child at his/her level of understanding.
- Assemble needed supplies and place on a clean surfact
- Review the student’s Diabetes Medical Management Plan/Healthcare provider’s order to ensure the proper dose of insulin is given
- If you have questions regarding the insulin dose, DO NOT GIVE THE MEDICATION, consult with the school nurse/healthcare provider, and parent/guardian before giving insulin dose
- Determine where the injection will be given on the student, with the student’s assistance as appropriate
- Check the six rights of medication administration to ensure that it is:
- The right student
- The right medication
- The right dose
- Being given at the right time
- Being given by the right route
- Being given for the right reason
- Ensure the medication has not expired
- If the medication has expired do not administer it, follow up with the parent/guardian and healthcare provider
- Review student’s allergy status
- Ensure proper documentation of parent/guardian authorization to administer the medication
- Check the insulin pen to see if the insulin cartridge is loaded into the insulin pen
- If not, load the insulin cartridge into the pen
- Wash your hands.
- Put on gloves.
- Review the six rights again to ensure that it is:
- For the right student
- The right medication
- The right dose
- Being given at the right time
- Being given by the right route
- Being given for the right reason
- Prepare the pen per the manufacturer’s instructions
- Wipe the top of the insulin pen with an alcohol swab if instructed to do so
- Attach a new capped needle onto the pen by screwing or clicking the needle into place (according to manufacturer’s instructions)
- A new needle is required for each dose administered
- If indicated, roll the insulin pen to mix the insulin
- Clear (fast-acting, long-acting) insulin generally does not need to be mixed
- Hold the pen with the needle pointing up and remove the outer needle shield
- Remove the inner needle shield and discard
- Be sure to not touch the needle
- Prime the insulin pen:
- Turn the dose knob clockwise until the number 2 is seen in the dose window
- Hold the pen with the needle pointing up
- Tap the clear cartridge holder gently so any air bubbles collect near the top
- Using your thumb, push the injection button firmly while counting to 5
- You should see a stream of insulin come out of the top of the needle
- Depending on the insulin pen, the dial should return to zero (0) or a diamond will appear in the center of the dose window
- After priming, turn the knob clockwise until the correct dose needed is seen in the window
- If you pass the correct dose amount, simply turn the knob backward until the correct dose is seen in the window
- If the student has dialed up the dose, have the student verify the correct does with you.
- If staff is administering the insulin, verify dose with a second adult
- Make sure the skin is clean
- It is generally not necessary to wipe the skin with alcohol before injecting
- Cleanse the injection site with soap and water, or an alcohol swab, and allow it to air dry; never fan or blow on the area cleansed with the swab.
- For those with limited body fat, it may be necessary to gently pinch a one to two inch portion of skin and fat between your thumb and finger
- With your other hand hold the pen like a pencil at a 90 degree angle into the skin and insert the needle with one quick motion
- Make sure the needle is all the way in
- Let go of the skin pinch before you inject the insulin
- Use your thumb to slowly push the button at the end of the pen to inject all of the insulin.
- Keep pressing and wait 10 seconds while keeping the insulin pen and needle in place to ensure that the insulin dose is given.
- When the injection is complete, the dial should return to zero (0) or have a diamond in the center of the dose window (depending on manufacturer)
- Remove the needle at the same 90 degree angle at which you inserted the needle
- Do not rub the injection site but press a clean gauze or cotton ball on the injection site with your finger for 5-10 seconds to keep insulin from leaking out
- Do not recap the needle. Have the student replace the other needle shield
- Direct student to remove the capped needle by turning it counterclockwise
- Have the student dispose of the needle in the approved sharps disposal container
- If the student is not able to complete this step, leave the needle on the insulin pen and use the one-handed scoop method to recap the needle with the other needle shield
- Place the needle shield on its side on a flat surface
- Hold the insulin pen in one hand and keep the other hand at your side
- Slide the needle into the outer needle shield and using only one hand, snap into place or push the capped needle gently into a solid surface to secure the shield
- Once insulin needle is recapped, remove the capped needle from the insulin pen by using a needle pliers or hemostat and dispose of needle in the sharps disposal container
- Remove gloves and wash hands.
- Document insulin administration, including date, time, dosage and site of injection.
- Return supplies to appropriate location.
- Follow-up with parent or guardian and healthcare provider, as needed.
References:
Association of Diabetes Care & Education Specialists. (2020). Insulin injection know-how. Learning how to inject insulin. Retrieved June 5, 2023, from https://www.diabeteseducator.org/docs/default-source/legacy-docs/_resources/pdf/general/Insulin_Injection_How_To_AADE.pdf
Centers for Disease Control and Prevention. (2008). Workbook for designing, implementing and evaluating a sharps injury prevention program. Retrieved June 20, 2023, from www.cdc.gov/sharpssafety/pdf/sharpsworkbook_2008.pdf
Diabetic care may be provided to students, when, trained personnel to be on site. Missouri Revisor of Statutes 167.809. (2013). https://revisor.mo.gov/main/OneSection.aspx?section=167.809
Eli Lilly and Company. (2020). Instructions for use. Humalog kwikpen® insulin lispro injection 100 units/ml, 3ml single-patient-use pen. Retrieved June 5, 2023, from https://pi.lilly.com/us/humalog-kwikpen-um.pdf
Eli Lilly and Company. (2020). Instructions for use. Humalog® junior kwikpen® insulin lispro (100 units/ml, 3 ml pen). Retrieved June 5, 2023, from https://pi.lilly.com/ca/humalog-jr-ca-ifu-kp.pdf
Levitsky, L.L., & Misra, M. (2023, March 29). Insulin therapy for children and adolescents with type 1 diabetes mellitus. In a J. I. Wolfsdorf (Ed.), UpToDate. Retrieved June 5, 2023, from https://www.uptodate.com/contents/insulin-therapy-for-children-and-adolescents-with-type-1-diabetes-mellitus
Lynn, P. (2019). Administering a subcutaneous injection. Skill checklists for Taylor’s clinical nursing skills. A nursing process approach. (5th ed.) (pp. 73-75).
National Association of School Nurses. (2022, June 15). School nursing evidence-based clinical practice guideline: Students with type 1 diabetes toolkit. Retrieved June 2, 2023, from https://cdn.fs.pathlms.com/HRuI7pAvQWiJPZdzH6i8
National Association of School Nurses. (2021). School nursing evidence-based clinical practice guideline: Students with type 1 diabetes. Silver Spring, MD: Author. Retrieved June 2, 2023, from https://learn.nasn.org/courses/37660
National Diabetes Education Program. (2016). Helping the student with diabetes succeed: a guide for school personnel. Retrieved June 2, 2023, from https://diabetes.org/sites/default/files/2020-02/NDEP-School-Guide-Full-508.pdf
Novo Nordisk. (2018). NovoPen Echo® quick guide. Retrieved June 5, 2023, from https://www.novo-pi.com/novopenecho.pdf
Perry, A. G., Potter, P.A., Ostendorf, W., & Laplante, N. (2021). Administering subcutaneous injections. In Clinical nursing skills and techniques. (10th ed.),(pp. 670-678). St. Louis, MO: Elsevier.
Sanofi-aventis U.S. LLC. (2022). How do you take apidra? The apidra SoloSTAR® pen. Retrieved June 5, 2023, from https://www.apidra.com/about/how-to-use
Training of school employees, content, requirements. Revisor of Statutes 167.803. (2013). https://revisor.mo.gov/main/OneSection.aspx?section=167.803&bid=8398&hl=.
Training of school employees in the care needed for students with diabetes. Missouri Secretary of State: Code of State Regulations. Division 20–Division of learning services. Chapter 200–Office of college and career readiness. (2022).https://www.sos.mo.gov/cmsimages/adrules/csr/current/5csr/5c20-200.pdf
Weinstock, R. S. (2022, August 11). Patient education: Type 1 diabetes: Insulin treatment (Beyond the Basics). In a D. M. Nathan (Ed.), UpToDate. Retrieved June 8, 2023, from https://www.uptodate.com/contents/type-1-diabetes-insulin-treatment-beyond-the-basics?topicRef=129412&source=see_link
Wyckoff, L. (2019). Students with diabetes. In Selekman, J. (Ed.), School nursing, a comprehensive text (3rd ed.). (pp. 575-602). Philadelphia PA.: F.A. Davis Co.
Page last reviewed: February 19, 2025
Page last updated: February 19, 2025
The information and materials presented in this Website are intended for informational purposes only and are not designed to diagnose or treat a health problem or disease, or assist in diagnosis or treatment of the same. The information is not intended to substitute for, supplement or replace clinical judgment. If there are any concerns or questions about or relating to a nursing or medical procedure, contact the individual’s healthcare provider. The information provided on this Website is not intended to be a substitute for medical orders and persons without the proper education, training, supervision and/or licensure should not perform the procedures.