Insulin by Syringe Administration

Endocrine

Pursuant to Sec. 5 CSR 20-200.300. Training of School Employees in the Care Needed for Students with Diabetes–Training of school employees in the care needed for students with diabetes shall take place prior to the commencement of each school year, or as needed when a student with diabetes is newly enrolled at a school or a student is newly diagnosed with diabetes, but in no event more than thirty days following such enrollment or diagnosis. The school nurse or another health care professional with expertise in diabetes shall promptly provide follow-up training and supervision as needed. Coordination, delegation, and supervision of care shall be performed by a school nurse or other qualified health care professional.

Pursuant to §167.818 RSMo. A student may perform certain diabetic care for self, when.— Upon written request of the parent or guardian and authorization by the student’s diabetes medical management plan, a student with diabetes shall be permitted to perform blood glucose checks, administer insulin through the insulin delivery system the student uses, treat hypoglycemia and hyperglycemia, and otherwise attend to the care and management of his or her diabetes in the classroom, in any area of the school or school grounds, and at any school-related activity, and to possess on his or her person at all times all necessary supplies and equipment to perform these monitoring and treatment functions. If the parent or student so requests, the student shall have access to a private area for performing diabetes care tasks.

Considerations:

The school nurse or other qualified health care professional must review the procedure with staff to ensure that they 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 insulin dose you draw up before administering it to be sure it is correct; check with your school nurse or the student’s health care 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 cap 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 health care information confidential.

Supplies:

Insulin vial
Gloves
Alcohol swabs
New insulin syringe
Sharps disposal container
Health care provider’s orders/Diabetes Medical Management Plan and student’s Individualized Health Care Plan (IHCP)
Parent/Guardian authorization form

Procedure for medication administration:

Explain the procedure to the child at their level of understanding
Assemble the needed supplies and place on a clean surface
Review the student’s Diabetes Medical Management Plan/health care provider’s orders to ensure the proper dose of insulin will be given
If you have any questions regarding the insulin dose, DO NOT GIVE THE MEDICATION, consult with the school nurse/health care provider, and parent/guardian 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:
1. The right student
1. The right medication
1. The right dose
1. Being given at the right time
1. Being given by the right route
1. Being given for the right reason
Ensure that the medication has not expired
1. If the medication has expired do not administer it, follow up with the parent/guardian and the health care 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:
1. The right student
1. The right medication
1. The right dose
1. Being given at the right time
1. Being given by the right route
1. Being given for the right reason
Inspect the vial to ensure that there are no 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
1. 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 insulin, verify the dose with a second Trained Diabetes Personnel who is present 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 a 90 degree angle to 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 plunger to inject all of the insulin
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 site 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 health care 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

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

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

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 J. Selekman, Shannon, R.A., Yonkaitis, C.F. (Eds.). School nursing, a comprehensive text (3rd ed., pp. 575-602). Philadelphia PA.: F.A. Davis Co.

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Acknowledgment of Reviewers:

Angie Bulmahn, MSN, RN, NCSN
School Nurse Specialist
Missouri Department of Health and Senior Services

Marjorie Cole, MSN, RN, FASHA
State School Nurse Consultant
Missouri Department of Health and Senior Services

Renee Falkner, BSN, RN
School Nurse Supervision Specialist | Therapylog

Katherine Park, DNP, RN, NCSN
Nationally Certified School Nurse, Pierremont Elementary
Adjunct Professor, Maryville University School of Nursing

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Page last updated February 21, 2024

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