Insulin Administration by Pen

<< ENDOCRINE


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.

Supplies:

  • Insulin pen
  • Gloves
  • Alcohol Swabs
  • Unopened needle
  • Insulin cartridge (may be inside insulin pen)
  • Authorized sharps disposal

procedure download skill competency
insulin-pen
Click on the photo to access the video.

  1. Explain the procedure to the child at his/her level of understanding.
  2. 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.
  3. Assemble the needed supplies and place on a clean surface.
  4. Review the student’s medication order to ensure the proper dose of insulin is given.
  5. If you have any questions regarding the insulin dose, DO NOT GIVE THE MEDICATION, consult with the school nurse before giving insulin.
  6. Determine where the injection will be given on the student, with the student’s assistance as appropriate.
  7. Check the insulin pen and the student’s medical order to ensure that it is
    1. For the right child
    2. The right medication
    3. The right dose
    4. Being given at the right time and
    5. Being given by the right route.
    6. Also check to ensure the medication has not expired.
  8. Wash your hands.
  9. Put on gloves.
  10. Recheck the insulin pen and the student’s medical order to ensure that it is:
    1. For the right child
    2. The right medication
    3. The right dose
    4. Being given at the right time and
    5. Being given by the right route.
    6. Also check to ensure the medication has not expired.
  11. Wipe the top of the insulin pen with an alcohol swab if instructed to do so. Attach the pen needle by twisting the needle onto the end of the insulin pen.
  12. Pull off and remove the outer pen needle protective cap and cover.
    • Be sure to not touch the needle.
  13. Prime the insulin pen by dialing 2 units.
  14. Push the end of the pen to push out the 2 units.
    • A small drop of insulin should be visible. If insulin does not appear, repeat.
  15. Dial the ordered insulin dosage to be administered to the student.
  16. 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.
  17. Gently pinch the skin of the chosen injection site and insert the pen needle at a 45-90 degree angle into the skin.
  18. While pinching skin, slowly push the button at the end of the pen to inject all of the insulin.
  19. Wait 5-10 seconds while keeping the insulin pen and needle in place to ensure that the insulin dose is given.
  20. Once 5-10 seconds have passed, release the skin and remove the insulin pen with needle from the injection site.
  21. Do not recap the needle.
  22. Dispose of the needle in an approved sharps disposal container.
  23. Remove gloves and wash hands.
  24. Document insulin administration, including date, time, dosage and site of injection.
  25. Return supplies to appropriate location.
  26. Follow-up with parent or guardian and healthcare provider, as needed.

Resources:

American Diabetes Association: Webinar: Safe at School: Keeping Kids with Diabetes Safe at School

American Diabetes Association: Training Resources

BD: How to Use an Insulin Pen

National Diabetes Education Program: Diabetes in Children and Adolescents Webinar Presentation

National Diabetes Education Program: Helping the Student with Diabetes Succeed: A Guide for School Personnel

Novolog: FlexPen


References:

American Diabetes Association.  (2014).  Diabetes Care in the School and Day Care Setting.  Diabetes Care, 37(1).  Available at: http://care.diabetesjournals.org/content/37/Supplement_1/S91.full.pdf+html

American Diabetes Association.  (2015).  Insulin Routines. Available at: http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/insulin/insulin-routines.html

Bowden, V. R., & Greenberg, C. S. (2012). Pediatric nursing procedures (Third Edition). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.


Acknowledgment of Reviewers:

The procedure list and video for this procedure were developed in collaboration with the Wisconsin Department of Public Instruction.

Bette Carr, MSN, RN, NCSN
School Nursing and Health Services Consultant
WI Department of Public Instruction

Teresa DuChateau, DNP, RN, CPNP
School Nurse Resource Coordinator
WI Public Health Association


Page last updated: July 24, 2015