Greater Glasgow and Clyde Medicines

Safe use of insulin for adults admitted to hospital - Administration

Part 3 – Safe Administration of Subcutaneous Insulin

This blog is the third in a series outlining risks relating to insulin prescribing and administration for adults in hospital, and at discharge and aims to provide good practice points to minimise these risks.

Key messages

• Incorrect storage and injection of insulin can lead to erratic blood glucose control and increase the risk of hypo- or hyperglycaemia.

• Clinical staff are advised to follow the NHSGGC ‘Key Insulin Safety Tips’ which can be accessed via Diabetes, Inpatient Prescribing FAQs for Junior Doctors (nhsggc.org.uk).

• Follow advice below on insulin devices, storage and how to administer.

Which Device?

• Patients on insulin before admission should be encouraged to bring in their own insulin pens from home to use while an inpatient.

• Disposable prefilled pens should be used for inpatients requiring subcutaneous (SC) insulin where possible. Some insulins are only available as vials or cartridges, e.g. Humulin S®, therefore, cartridges should be used with refillable pen devices for inpatients preferentially to vials.

• If a refillable pen device is needed e.g. Autopen®, Humapen®, Novopen® (into which insulin cartridges are loaded), or a patient reports a problem with any other administration or monitoring equipment, please contact the diabetes specialist nurse service.

• If a patient on a SC insulin pump, prior to admission, is unable to self-manage, they should be switched to variable rate intravenous insulin infusion (VRIII) and discussed urgently with the inpatient diabetes team.

Where to store?

• Stocks of insulin which have not yet been used for patients should be stored in the fridge between 2-8^○C.

• Once removed from the fridge the insulin pen should be labelled with a patient ID sticker and can be kept in the locked bedside medicines locker or ward drug trolley. Products are safe to use while out of the fridge (consult individual product literature or pharmacy for specific room temperature expiry guidance).

How to administer?

• To ensure patients can develop/maintain autonomy with their insulin administration, they should be encouraged to administer their own SC insulin dose where possible. This must be under nurse supervision (checking that the correct dose has been dialled up and administered correctly), unless the clinical area has a locally approved policy for self-management of insulin.

• If patients are finding it difficult to self-inject or are newly started on insulin, please refer to the diabetes specialist nurse service for education/review.

• If self-administering, check which type of needle the patient usually uses and ensure suitable needle tips are available.

• If staff are administering to a patient, ensure that insulin safety needles are used (these should not be supplied to the patient on discharge) and disposed of in an appropriate sharps container at point of use.

• Under no circumstances withdraw insulin from a cartridge or prefilled pen using a needle and insulin syringe. This contaminates the insulin, interferes with accurate dose determination using the pen device (including risk of overdose from high concentration preparations) and can cause the cartridge to shatter.

• Ensure insulin is prescribed on both HEPMA and the paper Insulin Prescribing and Administration Record (IPAR), and that both are signed with each administration (2 nurse signatures required on IPAR).

• Injection sites should be rotated to minimise development of lipohypertrophy or lipoatrophy, which can lead to erratic blood glucose control.

• Isophane insulin (e.g. Humulin I®) and mixed insulin suspensions (e.g. Humulin M3®, Novomix 30)® must be thoroughly mixed prior to use. The suspension should appear cloudy after mixing.

• Other insulin solutions should always appear clear. If unsure, consult the product information or contact pharmacy.

Refer to other blogs in the insulin safety series:

Safe Use of Insulin for Adults Admitted to Hospital – Summary of Blog Series
Safe use of insulin for adults admitted to hospital - Medicines Reconciliation
Safe use of insulin for adults admitted to hospital - Prescribing

Safe use of insulin for adults admitted to hospital - Discharge

Published 12/05/2023. Link to guideline updated 08/09/23. Medicines Update blogs are correct at the time of publication.

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