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 critical to give the exact dose ordered
- It is best practice to have a second person double check the insulin dose you draw up 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
- Do not shake the insulin vial
- The insulin syringe has a needle under the orange cover on the end. The barrel of the syringe has numbers and bars next to numbers to indicate the units of insulin. Underneath the cover on the other end is the plunger which you push to give the insulin
- 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 healthcare information confidential
Supplies:
- Insulin vial
- Gloves
- Alcohol swabs
- Insulin syringe
- Authorized sharps disposal container
- Healthcare provider’s orders
- Diabetes Medical Management Plan
- Student’s Individualized Healthcare Plan (IHCP)
Procedure:
- Explain the procedure to the child at his/her level of understanding.
- Assemble the needed supplies and place on a clean surface.
- Review the student’s Diabetes Medical Management Plan/medication order to ensure the proper dose of insulin is given.
- If you have any questions regarding the insulin dose, DO NOT GIVE THE MEDICATION, consult with the school nurse before giving insulin.
- 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:
- 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
- Ensure that the medication has not expired.
- If the medication has expired do not administer it, follow up with the parent/guardian and the healthcare provider
- Review the student’s allergy status
- Ensure proper documentation of parent/guardian authorization to administer medication
- 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
- Inspect the vial to ensure that there are not clumps or particles in it
- If the vial is new, date the vial with the current date, then remove the lid.
- Wipe the stopper with an alcohol swab.
- Carefully remove the cap from the insulin syringe without touching the needle.
- Pull air into the syringe by pulling back on the plunger until the TIP of the black plunger is equal to the dose of insulin.
- Hold the syringe like a pencil and insert the needle into the rubber stopper on top of the vial
- Push the plunger down until all of the air is in the bottle
- This helps to keep the right amount of pressure in the bottle and makes it easier to draw up the insulin
- Leave the syringe in the vial and turn the vial upside down being sure that the needle does not fall out of the vial.
- Pull insulin into the syringe slowly by pulling back on the plunger until the top of the TIP of the black plunger is equal to the dose of insulin.
- If present, remove air bubbles by tapping on the outside of the syringe and expelling the air or by pushing the dose back into the vial and pulling back on the plunger again to withdraw the correct dose of insulin.
- Remove the needle from the vial.
- Prior to administering the insulin, verify the dose with a second adult or the trained student
- 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 first finger.
- With your other hand, hold the syringe like a pencil at 90 degree angle to 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 plunger.
- Keep pressing and wait 10 seconds while keeping the syringe in and needle in place to ensure that the insulin dose is given.
- 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 stie with your fingers for 5-10 seconds
- Do not recap the needle
- Place used syringe in an approved 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
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
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.
Plan to be submitted by parent or guardian of student with diabetes — review by school. Revisor of Statutes 167.806. (2013). https://revisor.mo.gov/main/OneSection.aspx?section=167.806
StayWell Company, LLC. (2019). For kids: How to give yourself an insulin shot (single shot). Retrieved June 8, 2023, from https://stlouischildrens.staywellsolutionsonline.com/MultimediaRoom/VideoLibrary/?e=0#player:138,K2009
StayWell Company. LLC. (2021). Step-by-Step: Giving yourself an insulin shot. Retrieved June 8, 2023, from https://stlouischildrens.staywellsolutionsonline.com/MultimediaRoom/VideoLibrary/?e=0#player:138,A90341
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 20, 2025
Page last updated: February 20, 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.