Diabetes and Your Child: Giving Insulin
The digestive system breaks down food,
resulting in a sugar called glucose. Some of this glucose is stored in the liver.
of it enters the bloodstream and travels to the cells to be used as fuel. Glucose
help of the hormone insulin to enter the cells. Insulin is made in the pancreas, an
in the belly (abdomen). The insulin is released into the bloodstream in response to
presence of glucose in the blood.
Think of insulin as a key. When
insulin reaches a cell, it attaches to the cell wall. This signals the cell to create
opening that allows glucose to enter the cell. Without insulin, your child's cells
get glucose to burn for energy. This is why they may feel weak or tired.
The insulin your child is missing can
be replaced with shots of insulin (injections). Some children also use insulin pumps.
your child's body can burn glucose for energy. This helps keep your child's blood
within a healthy range.
At first, injecting insulin may seem
scary for both you and your child. But you will have help from your child's healthcare
provider, nurse, or diabetes educator. They will teach you how to give your child
injections. If your child is older, they can learn how to inject insulin. If so, you
still have to check the amount of insulin your child injects each time.
Types of insulin
There are many types of insulin.
Here are types your child will most likely use:
Fast-acting insulin. Fast-acting insulin must be taken with meals. Give it
to your child within 15 minutes before your child eats.
Regular or short-acting insulin. Short-acting insulin is also usually
taken before a meal. It will usually reach the bloodstream within 30 minutes after
Intermediate-acting insulin. Intermediate-acting insulin takes longer to
start working than fast-acting insulin. But it stays in your child’s bloodstream
Long-acting insulin. Long-acting insulin is in your child’s bloodstream at
all times. It helps keep their blood sugar levels within target range for long
Your child's healthcare provider
will prescribe the type or types of insulin that best fit your child's needs.
Choosing the injection site
How fast insulin starts working
depends on the type of insulin and where you inject it. Insulin is injected into the
just below the skin. It works quickest when injected into the belly. Other injection
sites include the back part of the upper arms, the buttocks, and the top and outer
of the thighs. Other things to keep in mind when choosing the injection site
Change the injection site
each time to prevent problems.
Allow about 1 inch between
Don’t inject in the area 2
inches around the belly button.
Ask your child's healthcare provider to teach you how to correctly
rotate the injection site and how to stay away from areas of lipohypertrophy. This
bump under the skin caused by injecting insulin in the same spot multiple times. Also
ask about the correct insulin injection technique and how to prevent injecting insulin
into the muscle. Accidentally injecting into the muscle or into an area of
lipohypertrophy can affect how insulin is absorbed.
Using a syringe
Always test your child’s blood
sugar before injecting insulin. Blood sugar readings help you decide how much insulin
give. Be sure to inject it into the fat just under the skin. Follow these steps for
using a syringe:
Step 1. Getting ready
Gather your supplies.
Wash your hands. Use soap
and warm water.
Wipe the rubber top
(stopper) of the insulin bottle (vial) with an alcohol wipe.
Prepare the insulin. If
your child uses cloudy-type insulin, roll the bottle gently between your hands
about 20 times. Don't shake the insulin. And don't use cold insulin. Instead,
keep 1 bottle at room temperature and store the rest in the refrigerator.
Step 2. Preparing the
These steps will take some
Remove the syringe from
Take the cap off the
Draw air into the syringe.
Pull back the plunger to draw air into the syringe. Pull the plunger back to
the mark (line) for the number of units of insulin you want to inject. The mark
on the syringe barrel nearest the needle is 0 (not 1).
Inject air into the
insulin bottle. Hold the bottle on a flat surface with one hand. With your
other hand, hold the syringe straight up and down. Slowly push in the plunger
to inject air into the insulin.
Turn the syringe and
bottle upside down. Keep the needle in the stopper. Flip the syringe and bottle
so that the bottle is now on top and the syringe is on the bottom. Be careful
not to bend the needle when tipping the insulin bottle.
Draw insulin into the
syringe. Keep the tip of the needle below the level of insulin. You may need to
pull the needle out slightly. Slowly pull back the plunger to draw out the
Check for air
bubbles. Gently tap the syringe while the needle is still in the stopper. The
air bubbles will move to the top of the syringe. Push the plunger in a tiny bit
to release the air bubbles back into the insulin bottle. Your child's
healthcare provider, nurse, or diabetes educator may show you other ways to
remove air bubbles.
Remove the needle from the
Step 3. Giving the
Clean the injection
site. Use an alcohol wipe to clean the area where you’re going to inject. Allow
the area to air-dry. If the skin is wet with alcohol, the injection will
Pinch an inch of
skin. Pull up about 1 inch of skin. Pinch the skin gently. Don’t squeeze it.
This is to prevent injecting into muscle.
Insert the needle. Insert
the needle into the skin at the angle you were shown.
Inject the insulin. Slowly
push in the plunger until the syringe is empty.
Step 4. Removing the needle
Count to 5. Then remove
Watch the injection site
for leaking insulin and bleeding. If the site bleeds, dab it with a cotton ball
or tissue. If insulin leaks, ask your child’s healthcare provider, nurse, or
diabetes educator to make sure you are doing it correctly.
Step 5. After the injection
Medicine that comes in a container
for a single dose should be used only 1 time.
Using an insulin pen
An insulin pen may be used to
inject insulin. They make it easy to give injections. Insulin pens hold insulin in
cartridges. A new needle is used for each injection. There are different kinds of
insulin pens. Talk with your child’s healthcare provider about what is best for your
Tips for pen use
Wash your hands with soap and
water before you begin.
Clean the injection site with
an alcohol wipe.
Use a new needle each
- There are different types of pen needles. Know what type you are
using and how to use it.
Standard pen needle: This needle often has a
removable outer and inner cover. Both covers need to be removed before the
Safety pen needle: This needle has a
removable outer cover. The inner cover is a fixed safety shield that is not
removed. Instead, the shield will be pushed back. This will expose the needle
as the injector is pressed against the injection site.
- When you get a new box of needles, always check to see what kind
of needle it is. It might be different from what you are used to. If you are not sure
how to use the new needles, talk with your healthcare provider.
Never leave the needle on the
insulin pen when you’re not using it.
Before injecting, tap the
needle with your fingertip to get rid of air bubbles.
Test the pen by dialing to 2
and pressing the injection button all the way. Insulin should come out of the
needle when you do this. If not, check for air bubbles again.
Test again. If no insulin
comes out after 3 tries, start over with a new needle.
An adult should check the
dose that a child dials.
Pinch an area of skin and
insert the needle. Push the button down all the way. Then count to 10 while
injecting the insulin. Pens take longer than syringes to deliver insulin.
Smart pens, now called connected insulin pens (CIPs), are also
available. These pens can be programed to calculate insulin doses. They can also send
data to your smartphone.
If your child has had trouble controlling their blood sugar, they
may be eligible to use an insulin pump. A pump delivers insulin throughout the day,
with no need for multiple injections. The FDA has approved insulin pumps for children
as young as age 2.
Store unopened insulin in the
refrigerator. An open bottle can be stored at room temperature, such as on the
kitchen counter. But don’t let the insulin get too hot. Always keep it below 86°F
(30°C). And never let it freeze!
Throw away expired insulin.
This is true even if you haven't opened it.
Use insulin within 28 days of
opening it. Write the date you opened it on the bottle.
Check that your child carries
their insulin and injection supplies in a bag made to protect them from heat and
Overcoming fear of injections
Injections may be hard for both you
and your child. But there are things you can do to make it easier. To calm your child’s
Treat injections as normal
Ask about giving yourself a
test injection with saline. That way you will know how an injection feels.
Praise your child for not
delaying or making excuses. If your child needs to complain, give them time for
that after the injection is over.
If your child is afraid of
needles, ask your child's healthcare provider, nurse, or diabetes educator for
help. For example, ask about devices that block your child's view of needles.
Your child’s role
As your child gets older, they may
want to help with injections. Just make sure it is their decision. You can help your
child by letting them:
Figure out how much insulin
Choose the injection
Draw insulin into the
syringe. You should check the dose.
Push on the plunger to inject
Practice injections on an
To learn more
For more information about
diabetes, visit these websites: