Insulin and Injections at Home: What Families Can and Cannot Do

What you can and cannot decide

Families can usually: - remind and supervise, and give the injection once trained; - check blood sugar with a meter if shown how, and record readings; - store the insulin, rotate sites, track supplies and prepare the equipment; - spot low and high sugar signs and act on the plan the doctor has given; - keep the diary and bring it to appointments.

Families should not: - change the dose, type or timing on their own, even if readings seem high or low. The doctor or diabetes team adjusts doses based on the pattern of readings. Where a doctor has given a written plan for adjusting doses, follow it exactly and no more. - give someone else's insulin or reuse leftover supplies; - give injections without training; - skip a dose because the person is not eating without first calling the doctor for advice, since insulin needs vary with illness and meals, and the advice differs by insulin type; - stop insulin because of fear of dependence or a rumour, which can be dangerous.

If you are unsure at any point, ring the doctor, nurse or pharmacist before giving the injection, not after.

Getting trained

Ask the doctor or hospital diabetes clinic for a teaching session for you and your parent, and bring the actual device. Ask the nurse to watch you give an injection and correct you. Ask for it in your language, with written steps. Topics to cover:

• the type of insulin or injectable medicine, what it does and when it works;
• the device (pen or syringe), how to set the dose, check it and prime it;
• injection sites, rotation and technique, and how to avoid lumps;
• how to read and record blood sugar, and what the targets are for your parent;
• what to do if a dose is missed, or if the person is unwell, vomiting, not eating or fasting;
• low and high sugar symptoms and what to do;
• storage, travel and power cuts;
• sharps disposal;
• who to call, and when.

A refresher is wise every year, and after any change in device or insulin. See insulin dosage chart for diabetic patients for general information only; the dose for your parent is whatever the doctor has written.

Safe practice, in outline

These steps outline good practice; your nurse will show the details.

1. Wash your hands and the person's skin site if dirty. 2. Check the label: right medicine, right person, right dose and right time, and check the expiry and appearance. Do not use insulin that has changed colour, is clumpy when it should be clear, or has passed its date or storage limits. 3. Check blood sugar if the doctor has told you to do so before the dose, and do not give the dose if you are unsure of the reading or the person is unwell without calling the doctor. 4. Use a new needle each time, and attach it as shown. 5. Dial the exact dose, and double-check it, especially in dim light or with poor eyesight. A second person can check. 6. Choose and rotate the site as taught, such as the abdomen, thigh or back of the upper arm, avoiding lumps, scars, bruises and areas that are painful. Rotating prevents lumps that make insulin absorb poorly. 7. Inject as taught, hold the pen in place for the number of seconds advised, and remove it. 8. Dispose of the needle immediately in a sharps container. Never recap by hand unless shown how, and never throw loose needles in household waste. 9. Record the date, time, dose and site in the diary. 10. Make sure the person eats at the planned time. Insulin without food can cause a dangerous low.

Storage and travel

• Unopened insulin is usually kept in a refrigerator, away from the freezer compartment; never use insulin that has frozen.
• In-use insulin is typically kept at room temperature for a limited number of days, written on the leaflet; mark the date opened on the pen.
• Heat is the enemy. Do not leave insulin in a hot car, in direct sun, near a stove or on a window ledge. In Indian summers, use an insulated pouch, and plan for power cuts; see hospital bed electricity and power cuts for ideas on backup planning, and ask the pharmacist about cooling cases.
• Travel: carry insulin and supplies in hand luggage, with a doctor's letter and the prescription; do not check them into the hold; see travelling for treatment with an elderly parent and travel with an elderly parent checklist.
• Keep spare pens, needles, meter strips and a sugar source.

Sharps disposal

Used needles, lancets and syringes can injure family members, waste collectors and neighbours, and spread infection. Use a rigid, puncture-resistant, closable container, such as a dedicated sharps bin or a thick plastic bottle with a screw cap, kept out of children's reach. When about three-quarters full, seal it and ask the clinic, hospital or pharmacist how to dispose of it in your area; rules and services vary, so check with them or your local municipal health office. Never put loose sharps in ordinary bins. See infection control for home caregivers.

Low blood sugar (hypoglycaemia)

This is the most dangerous short-term risk of insulin. Older adults may have fewer warning signs. Watch for: sweating, shakiness, hunger, pale skin, fast heartbeat, headache, dizziness, confusion, unusual behaviour, drowsiness, slurred speech, irritability or sudden tiredness. A reading below about 70 mg/dL (or the threshold your doctor has given) counts as low.

If the person is awake and able to swallow: give a quick sugar source as taught by your team, such as glucose or sugar in water or fruit juice, wait about 15 minutes, recheck blood sugar and repeat if still low; follow with a snack or meal when recovered. Then tell the doctor the same day.

If the person is drowsy, cannot swallow safely, is unresponsive, has a seizure or cannot be woken: call 112 immediately. Do not put food or drink in their mouth. Place them on their side and stay. Ask the diabetes team in advance whether an emergency injectable should be kept at home, and have them train you.

See diabetes and low sugar emergencies and diabetes at home after 60.

High blood sugar and sick days

Persistent high readings, thirst, passing a lot of urine, tiredness, blurred vision, vomiting, fast breathing, abdominal pain, drowsiness or confusion need medical advice the same day. Call 112 for severe drowsiness, vomiting with fast breathing, collapse or confusion. When the person is ill, with fever, vomiting or diarrhoea, or not eating, ask the doctor in advance for a sick-day plan; do not stop insulin without advice.

Other injections

Some people are prescribed injections for bone health, blood thinning, anaemia, arthritis or other conditions. The same principles apply: train, check label and dose, rotate sites, dispose of sharps safely, store correctly and report problems. Blood thinner injections carry bleeding risk; see atrial fibrillation and blood thinners. Do not use injections that are not prescribed for the person.

Supporting your parent

Needle fear, loss of independence and embarrassment are common. Speak respectfully. If your parent can still give their own injections, keep it that way and offer supervision. Involve them in site choices and routine. Watch for low mood and burnout, in yourself and in them; see caregiver burnout signs and prevention.

When to ask a professional

A diabetes nurse educator or doctor teaches injection technique, sets doses and gives sick-day advice. A pharmacist advises on storage, devices and disposal. A dietician helps plan meals. An eye doctor checks vision, which affects dose-dialling. In an emergency, call 112.