Insulin injections

​Injecting a child with insulin​ is probably one of the biggest challenges parents face. Many are nervous about needles, so it can be hard to think of giving one to their own child. Some children are also frightened of needles, which makes the adjustment difficult. With practice, however, children and parents quickly grow comfortable with administering insulin. And increasingly, children prefer to receive their insulin using pre-loaded injectable pens.

Teenagers, and some younger children, quickly become quite good at taking their own insulin. At first, however, both parents need to become skilled at this too. Other caregivers, such as grandparents and babysitters, should also be able to give an injection in case of illness or emergency.

Older children who are preparing and injecting their own insulin must be supervised. This must be done to ensure that the dose is accurate, the insulin is actually injected, and the child does not use the same injection site day after day. Supervision will remind them that insulin is important and could be dangerous if too much is given at one time. When there is sufficient amount of support, families adapt better to diabetes management.

• Needles and syringes
• Preparing a syringe with a single-type insulin
• Preparing a syringe with a mixture of insulin types
• How to inject insulin using a syringe

Needles and syringes

Syringes

Syringes are designed to measure different amounts of insulin. Insulin syringes are generally available in three sizes:

• 3/10 mL (for doses of 30 units or less)
• ½ mL (for doses of 31 to 50 units)
• 1 mL (for doses of 51 to 100 units)

The syringe has three parts: the needle, the plunger and the barrel.

Needles

Needles are available in many lengths and thicknesses. Thickness is measured by gauge. The higher the gauge number, the finer the needle. For example, a 31-gauge needle is thinner than a 29-gauge needle. Generally, children prefer finer needles because they hurt less.

The length of the needle on an insulin syringe is measured in millimeters (mm). Length varies from the standard 12.7 mm to the shortest 6 mm needle. In comparison, the shortest needle on an insulin pen is 4 mm.

Young children take their cues from their parents. Any fear or dislike you have of needles may make your child afraid too. Some parents find that reminding themselves that the insulin injection allows their child to survive and stay healthy makes injection time easier. If parents say, “I need to give you your insulin so you will have lots of energy to play and to grow,” the child begins to understand. Follow up each needle with a big hug and kiss, and get on with the day’s activities. 

Preparing a syringe with single-type insulin

This interactive animation will walk you step by step through the preparation of a syringe with single-type insulin. Here is an overview.

1. Collect the items you will need: an insulin syringe, the bottle of insulin, an alcohol swab, and your child’s insulin log book and sharps disposal container. If your child is younger, you may want to complete these steps in a different room to minimize the disruption for your child.
2. Wash your hands with warm, soapy water. Rinse and dry them well.
3. Check the label on the insulin to make sure you have the right kind and that it has not expired.
4. Mix insulin uniformly. Do not shake the bottle or the insulin will become frothy and hard to measure accurately.
5. Check your child’s insulin log to make sure you know how much insulin you will need to withdraw.
6. Without removing the needle cap, pull back on the plunger to draw up air.
7. Insert the needle into the rubber stopper on top of the bottle.
8. Push down on the plunger to inject all the air into the bottle.
9. Turn the insulin bottle upside down.
10. Pull back on the plunger and draw out the right units of the insulin that you need.
11. Once you have successfully drawn the right number of units of insulin from the bottle, remove the needle from the bottle.
12. Replace the needle cap for safety if you are going to be moving to another room to do the injection.
13. Inject the insulin.
14. Dispose the syringe in a sharps disposal container.

Preparing a syringe with a mixture of insulin types

Most children need two different types of insulin delivered in one injection. For example, the pre-breakfast injection will likely include some rapid-acting insulin to work with the food in the coming meal and some intermediate-acting insulin that will peak later in the day.

This interactive animation details the steps for preparing a syringe with a mixture of cloudy and clear insulin. Please note that you should never prepare a mixture of two clear insulins.

Here is an overview.

1. Collect the items you will need to mix insulin: an insulin syringe, the two types of insulin in bottles that your child will need to take, an alcohol swab, your child’s insulin log, and a sharps disposal container. (If your child is younger, you may want to complete these steps in a different room to minimize the disruption for your child).
2. Wash your hands with warm, soapy water. Rinse and dry them well.
3. Check the labels on the insulin to make sure you have the right kinds and that they have not expired.
4. Take the cloudy (intermediate-acting) insulin bottle and roll it gently between your hands for 5 to 10 seconds to uniformly mix it. Do not shake the bottle or the insulin will become frothy and hard to measure accurately. Clear (rapid-acting) insulin bottles do not need to be rolled.
5. Inject the right number of units of air in each bottle but do not withdraw any insulin yet.
6. Always draw up the clear (rapid-acting) insulin first then the cloudy (intermediate-acting) insulin last. Once you have drawn the right amount of rapid-acting insulin, remove the syringe from the bottle. Then draw the necessary number of units from the intermediate-acting insulin bottle. If you accidentally pull the plunger back too far when adding the intermediate-acting insulin, throw out the entire insulin-filled syringe to your sharps disposal container and restart with a new syringe and go back to step 4.
7. Once you have successfully drawn the right volume of intermediate-acting insulin, remove the needle from the cloudy insulin bottle. Double check that you have the right total number of units of insulin in the syringe. Double check the total number of insulin units syringe with another person who is familiar with your child’s regimen, if possible.
8. Inject the insulin.
9. Dispose of the syringe in a sharps disposal container.

Note that mixing different types of insulin at home in different amounts cannot be done if you are using pens , as pens are already pre-filled and ready for use.

How to inject insulin using a syringe

1. Collect the items you will need to inject insulin: an insulin-syringe properly loaded with the right number of units of insulin your child will need, a dry cotton swab, your child’s insulin log and a sharps disposal container.
2. Wash your hands with warm, soapy water. Rinse and dry them well.
3. Determine which site you should be using for the injection to ensure proper site rotation .
4. Hold the syringe in your dominant hand for better control.
5. Gently pinch up the skin and fat with your other hand using your thumb and forefinger.
6. Stick the needle quickly into the injection site at a 90-degree angle to the pinched-up skin. For leaner children, inject at a 45-degree angle to the pinched-up skin.
7. Push the plunger down smoothly with your index finger to inject the full dose of insulin and hold for 5 seconds while maintaining the lift.
8. Remove the needle, then let go of the pinched skin last; this will help prevent any insulin from leaking out of the site.
9. Use a dry cotton swab to gently apply pressure to the injection site. The pressure will help prevent bruising.
10. Discard the syringe in your sharps disposal container. Never leave unused needles lying around.