Building Independence: Insulin

Building Independence in Diabetes Skills… What Does My Child Need to Know about:

We all know that eventually our T1D child needs to be able to complete diabetes self-care tasks for themselves. But how do we hand over that baton? The first step is identifying the concrete skills that we need to teach them.

Ask yourself if your child can – and will – independently do all of the following tasks related to mixing and using insulin. If you answered “no” to a certain step, that could become a teaching target to move your child towards independence.

Steps for Delivering Insulin, Adjusting Insulin Doses:

A. Delivering Insulin

Delivering Insulin via Syringe:

  1. If using Humulin N or NPH, mixes the cartridge or vial properly.
  2. Accurately draws up correct amount of insulin, ensuring that there are no bubbles.
  3. Chooses an injection site (good absorption, not overused).
  4. Injects the insulin.
  5. Disposes of the syringe safely.
  6. Effectively rotates sites.
  7. Recognizes the signs and symptoms of a possible site infection, and alerts caregiver.


Delivering Insulin via Insulin Pen:

  1. If using Humulin N or NPH, mixes the cartridge or vial properly.
  2. Holds pen upright and shoots 2 units into the air.
  3. Dials correct insulin dose.
  4. Chooses an injection site (good absorption, not overused).
  5. Applies needle tip to injection site.
  6. Injects the insulin.
  7. Holds pen in place for 10 seconds.
  8. Removes needle tip from injection site.
  9. Caps the insulin pen after use.
  10. Disposes of needle tip safely when needed.
  11. Effectively rotates sites.
  12. Recognizes the signs and symptoms of a possible site infection, and alerts caregiver.


Delivering Insulin via Insulin Pump:

  1. Navigates menus to arrive at screen showing suggested dosage.
  2. Correctly identifies the suggested dose.
  3. Dials in the correct dose:
    1. To match the suggested dose, OR
    2. Adjusts up or down according to personal experience
      (based on amount of insulin still active, exercise planned or completed, glycemic index of food just eaten, etc).
  4. Actually delivers insulin dose by confirming the selection.
  5. Ensures insulin was actually delivered by checking the end screen for the absence of error messages.
  6. If error message:
    1. Checks pump history to determine how much, if any, insulin was delivered.
    2. Determines how much, if any, insulin needs to be re-delivered (if less than the total intended dose was delivered).

B. Determining correct timing of insulin (when to deliver for optimal control):

      1. Boluses before eating.
      2. Adjusts timing based on blood glucose.
      3. Adjusts timing based on Glycemic Index.

More information on the Glycemic Index and its Effect on Blood Glucose:

An Introduction to the Glycemic Index
The Glycemic Index Explained
Adjusting for GI Level

C. Adjusting Insulin Dosages:

Note that this is an advanced skill, which is a challenge for many adults to master, so caution is needed to maintain reasonable expectations. As such, this section is appropriate *for ADULTS/YOUNG ADULTS/SOME TEENS ONLY, with the guidance of caregivers and/or health care team.*

  1. Reviews data (meter, pump, CGM) and/or logbook regularly.
  2. Notices trends in highs and lows
    1. at certain times of the day
    2. with certain activities.
    3. on certain days of the week (ex. weekends vs. weekdays) or of the month (ex. related to menstrual cycle)
  3. Adjusts insulin dosages accordingly.
  4. Monitors results of change in insulin dosages.
  5. Repeats 1-4 (directly above) as needed.

The above information was reviewed for content accuracy by clinical staff of the Alberta Children’s Hospital Diabetes Clinic.

This material has been developed from sources that we believe are accurate, however, as the field of medicine (in particular as it applies to diabetes) is rapidly evolving, the information should not be relied upon, as it is designed for informational purposes only. It should not be used in place of medical advice, instruction and/or treatment. If you have specific questions, please consult your doctor or appropriate health care professional.