Diabetes in Children: Giving Insulin Shots to a Child

Insulin is a hormone produced in the pancreas. It lets sugar (glucose) enter body cells, where it is used for energy. It also helps the body store extra sugar in muscle and liver cells. The stored sugar can be released later and used for energy when needed.

Insulin for injection comes in small glass bottles, or vials, and in cartridges. Both are sealed with a rubber lid. One vial or cartridge contains many doses. To remove a dose of insulin from:

• A vial: Use an insulin syringe. The syringe is also used to inject the insulin.
• A cartridge: Use a pen-shaped device called an insulin pen. The cartridge fits inside the pen and the dose of insulin is set with a dial on the outside of the pen. The pen is used to give the insulin. Both disposable and reusable insulin pens are available. Each pen operates slightly differently.

Note: If your child is using a disposable insulin pen, talk with your child's doctor or pharmacist about how to use the pen properly. Giving insulin with these pens is not covered in this information.

To give an insulin injection, the needle is inserted through the skin. The medicine is pushed from the syringe into fatty tissue just below the skin. Insulin usually is injected into the abdomen, upper arm, buttocks, or thigh.

Your child may need to take two types of insulin at the same time. Because most types of insulin that are prescribed to be taken at the same time can be mixed together, you can give both doses in the same syringe.

Continue to Why?

If your child has type 1 diabetes, his or her body no longer produces insulin. Because insulin is not available, sugar cannot enter body cells to be used for energy. As a result, the blood sugar level rises. Insulin injections are necessary to keep blood sugar levels within a target range when a person has type 1 diabetes.

If your child has type 2 diabetes, either the pancreas isn't able to produce enough insulin or your child's body tissues have become resistant to insulin. Children with type 2 diabetes may need to take oral diabetes pills to control their blood sugar.

Your child with type 2 diabetes may need insulin if eating a balanced diet, getting regular exercise, and taking diabetes pills have not kept his or her blood sugar levels within a target range. Your child may now need insulin injections either alone or in combination with oral medicine.

Continue to How?

Your doctor will help you and your child learn to prepare and give insulin injections. If your child is age 10 or older, he or she may be able to give insulin with supervision. Here are some simple steps to help you and your child learn this task.

Get ready

To get ready to give an insulin injection, follow these steps.

1. Wash your hands with soap and running water. Dry them thoroughly. If your child is going to help, wash his or her hands well.
2. Gather the supplies. You will need an insulin syringe, the vial(s) of insulin, and an alcohol wipe or a cotton ball dipped in alcohol. Keep the supplies in a bag or kit so your child can carry the supplies wherever he or she goes.
3. Check the insulin bottle label and contents. When an insulin vial is used for the first time, write the date on the bottle. On the 30th day after opening, throw the bottle with any remaining insulin away. Insulin may not work as well after 30 days of use.

Prepare the injection

The preparation will depend on whether you are giving one type of insulin or mixing two types of insulin in the injection.

• To prepare an injection with a single type of insulin, follow the instructions in the slideshow of steps for preparing a single dose of insulin.
• To prepare an injection containing two types of insulin, follow the instructions in the slideshow of steps for preparing a mixed dose of insulin.

When you are mixing types of insulin to be given in one syringe, follow these precautions.

• If you are mixing NPH and short-acting regular insulin, you can use it right away or refrigerate it to be used later.
• Insulin glargine (Lantus) and insulin detemir (Levemir) cannot be mixed with other types of insulin. They also cannot be given in a syringe that has been used to give another type of insulin.
• Lente insulin should not be mixed with regular insulin.
• Do not mix human- and animal-source insulins in the same syringe.

Prepare the site

Before giving the injection, take the time you need to do the following:

• Choose the place (injection site). See the diagram of injection areas for where to give insulin injections. The belly is the most common area. If you give the injections in different places on your child's body each day (rotate sites), use the same site at the same time of the day. If your child will be physically active soon after the injection, use a site that will have the least movement in the activity. The absorption of insulin is faster in an area that gets movement, which could lead to low blood sugar. For example, if you give your child an insulin shot right before he or she plays soccer, give the shot in the belly, rather than in the leg.
• An example of rotating sites:
  • At breakfast, give the insulin into one of your child's arms.
  • At lunch, give the insulin into one of your child's legs.
  • At dinner, give the insulin into your child's abdomen.
• Clean the site. If you use alcohol to clean the skin before you give the injection, let it dry.
• Have your child relax the muscles in the area of the injection.

Give the injection

Follow these steps for giving an insulin injection.

1. Slightly pinch a fold of skin between your fingers and thumb of one hand.
2. Hold the syringe like a pencil close to the site, keeping your fingers off the plunger. Usually the syringe is at a 90-degree angle to the skin site. If you are giving the injection to a small child with little fat, you may want to insert the needle at a 45-degree angle.
3. Bend your wrist and quickly push the needle all the way into the pinched-up area. Then let go of the pinched-up area.
4. Push the plunger of the syringe all the way in so the insulin goes into the fatty tissue. Count to 5 before taking the needle out, so that some of the insulin doesn't "leak" out.
5. Take the needle out slowly at the same angle that you inserted it. If your child bleeds a little, apply pressure over the injection site with your finger, a cotton ball, or piece of gauze. Do not rub the area.
6. Replace the cover over the needle. Although syringe manufacturers do not recommend it, some people reuse their syringes until the needle becomes dull or bent. If you plan to reuse your syringe, see precautions when reusing syringes.

View the slideshow on giving an insulin injection into the belly using an insulin pen to see photographs of a child using an insulin pen to give an injection in the belly.

View the slideshow on giving an insulin injection into the arm to see photographs of a child giving an insulin injection in the arm using a syringe.

Cleanup and storage

After giving your child's injection, be sure to:

• Store the insulin properly so that each dose from the bottle will work effectively.
• Dispose of the used syringe and lancet. Do not throw a used syringe, needle, or lancet in a trash can. You can dispose of them in a metal container with a lid that screws on or that you tape down tightly. You also can buy special containers for disposing of used needles and syringes. You can buy a small needle clipper device that breaks the needle off the syringe and stores it safely for disposal. Talk with your local trash disposal agency or your doctor about how to get rid of the container.

Other tips for success and safety

Some tips to help you be safe and successful in giving your child insulin injections include the following:

• Teach other family members how to give insulin injections. Have at least one other person who can prepare and give your child's insulin injection in an emergency. It's a good idea to let this person give your child an injection periodically for practice. Then it will not be as unfamiliar when an emergency occurs.
• Do not mix other medicine with insulin without your doctor's instruction. Some types of insulin cannot be mixed together.
• Never share syringes with another person because of the risk of getting diseases that can be transferred through blood, such as acquired immunodeficiency syndrome (AIDS) or infection of the liver (hepatitis).

Continue to Where?

Now that you have read this information, you are ready to start preparing and giving insulin injections to your child.

Talk with your child's doctor

If you have questions about this information, take it when you visit the doctor. You may want to mark areas or make notes in the margins on the pages where you have questions.

If you would like more information on preparing and giving insulin injections, the following resources are available:

Organization

American Diabetes Association (ADA)
1701 North Beauregard Street
Alexandria, VA  22311
Phone:	1-800-DIABETES (1-800-342-2383)
Email:	AskADA@diabetes.org
Web Address:	www.diabetes.org
The American Diabetes Association (ADA) is a national organization for health professionals and consumers. Almost every state has a local office. ADA sets the standards for the care of people with diabetes. Its focus is on research for the prevention and treatment of all types of diabetes. ADA provides patient and professional education mainly through its publications, which include the monthly magazine Diabetes Forecast, books, brochures, cookbooks and meal planning guides, and pamphlets. ADA also provides information for parents about caring for a child with diabetes.