Building Independence: Insulin

passing the T1D baton: Delivering + Adjusting Insulin

We all know that eventually our T1D child needs to be able to care for their diabetes for themselves. But how do we hand over that baton? The first step is identifying the concrete skills that we need to teach them. Here we will zoom in on the sub-skills that your child/teen needs to know to mix and deliver insulin (using an insulin pen, syringe, or insulin pump) and adjust insulin doses - safely, effectively and independently. Why not pick one now and work toward its mastery?

Here is a list of sub-skills related to mixing and using insulin, including delivering a dose of insulin safely and effectively, as well as adjusting insulin rates and ratios. Ask yourself if your child/teen can – and will – independently do all of the following tasks. If you answered “no” to a certain step, that could become a teaching target to move your child towards independence.

A. Delivering Insulin:

  • Using a 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.


  • Using an 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.


  • Using an Insulin Pump:

    1. Navigates menus to arrive at screen showing suggested dosage.
    2. Correctly identifies the suggested dose.
    3. Dials in the correct dose:

a. to match the suggested dose, OR

b. adjusts the dose up or down as needed (based on amount of insulin still active, exercise planned or completed, glycemic index of food just eaten, etc).

    1. Actually delivers insulin dose by confirming the selection.
    2. Ensures insulin was actually delivered by checking the end screen for the absence of error messages.
    3. If an error message pops up:

a. Checks pump history to determine how much, if any, insulin was delivered.

b. Determines how much, if any, insulin needs to be re-delivered (if less than the total intended dose was delivered).

B. Timing of Insulin Delivery:

(determining the best time to give insulin for optimal BG management)

  1. Boluses before eating.
  2. Adjusts timing based on blood glucose (longer pre-bolus time if BG is above target; shorter pre-bolus time if BG is below target).
  3. Adjusts timing based on Glycemic Index.

C. Adjusting Insulin Doses and Carb Ratios:

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:
    a. at certain times of the day
    b. with certain activities.
    c. 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.