Injecting a child with insulin is probably one of the biggest challenges parents face. Many are nervous about needles, so it’s hard to think of giving one to their own child. Teenagers, and indeed some younger children, quickly become quite good at taking their own insulin. At first, however, both parents need to become skilled at this too. Other caregivers such as grandparents and babysitters should also be able to give an injection in case of illness or emergency. Children who are preparing and injecting their own insulin must be supervised. This must be done to ensure that the dose is accurate, the insulin is actually injected, and the child doesn’t use the same injection site day after day. Supervision will remind them that insulin is important and could be dangerous if too much is given at one time. When both parents are involved, the mutual support helps families adapt better to diabetes.
Getting your child to take needles
Children take their cues from their parents. Any fear or dislike you have of needles may make your child afraid too. Some parents find that reminding themselves that the insulin injection allows their child to survive and stay healthy makes injection time easier. If parents say, “I need to give your insulin so you’ll have lots of energy to play and to grow,” the child begins to understand. Follow up each needle with a big hug and kiss, and get on with the day’s activities. Here are some ideas and common questions that parents have around giving their child a needle.
Giving the injection
- Gather together the insulin-loaded syringe and a dry cotton swab or tissue.
- Select the injection site.
- Gently pinch up the skin and fat with the thumb and forefinger.
- Hold the syringe like a pencil, close to the needle for better control.
- Push the needle in quickly and all the way, at a 90-degree angle to the pinched-up skin.
- Push the plunger in to inject the insulin.
- Slowly let go of the pinched-up skin and then remove the needle.
- Using a dry swab, apply gentle pressure to the injection site to prevent bruising.
- Discard the needle and syringe in a special container, available at your pharmacy, or recycle a juice can or empty bleach container. To avoid possible injury, never leave used needles lying around.
Giving injections: ideas and questions
Who should give the injection?
In many families, one person takes on most of the responsibilities for injections. However, there may be problems when that person is not there. It’s important for all regular caregivers to share responsibility for giving the injection. Your child should feel safe and confident with any of them. Single-parent families should get the help of a friend or relative. Some families work out a schedule. One parent might take care of the morning injections and the other parent looks after evening injections.
Sharing the burden is also important to cope with the daily demands of diabetes and to prevent parent burnout.
How old do children have to be before they can give their own injections?
There’s no magic age at which children are suddenly able to give their own injections. Generally, by 9 or 10 years of age, they have the physical ability to draw up and give their own insulin. However, children this age lack judgment. They usually need you to supervise them into their teenage years. This means that you need to watch your child prepare the dose and insert the needle, check the expiry date on the insulin bottle, and remind your child to move injection sites around.
Even at younger ages, many children are curious and want to take part in some parts of the routine. Eventually they will reach the age when they want to go on sleepovers or spend more time away from home. Then it will become more important for them to show that they can safely manage their own diabetes routines. This is a gradual process for both parents and child. Many children learn to give their first needle or to try new sites at diabetes summer camps.
What if some insulin leaks out of the injection site?
When insulin leaks, don’t try to guess the amount lost and replace it. The risk of giving too much insulin and then causing a low blood sugar reaction is too high. Note it in your logbook and take it into account if the next blood check is high. In the meantime, here are a few tips to reduce such occurrences:
- Get rid of anything that may cause extra pressure at the injection site, such as a bent leg or a chair pressing against the buttock.
- Gently pinch the skin and pull it slightly to the side before injecting. When you let go, the skin falls back into place and covers the needle track.
- Inject the insulin slowly.
- Let go of the pinched skin before removing the needle to avoid squeezing the insulin back out.
- Count to 5 before removing the needle.
- Apply light pressure on the injection site for a couple of seconds as you remove the needle, to prevent blood and insulin from coming out.
- If you are using a very short needle, try a longer one.
What does it mean if there is bruising at the injection site?
This can happen from time to time. It is not harmful. It usually means the needle has nicked a tiny blood vessel. To reduce the chance of bruising, apply gentle pressure to the site with a dry piece of cotton or a clean finger after injecting. Also, be careful not to pinch the skin too tightly or insert the needle too slowly. If you have too much bruising, consult your diabetes team.
Are premixed insulins better than mixing your own insulin?
Premixed insulins may be more convenient, but they don’t give you as much flexibility. With children, the insulin dose changes often due to growth and changes in appetite and activity. Ideally, families should be able to change doses of intermediate and rapid-acting insulins. Premixes don’t allow for this.
Should injection sites be cleaned with alcohol?
Most diabetes centres no longer include alcohol swabbing as part of their injection technique. There’s no evidence to show that brief alcohol swabbing has any effect when people bathe regularly. Injection site infections are exceptionally rare.
What causes the injection site to be red and itchy?
Some children are sensitive to rubbing alcohol or one of the components of the insulin solution. The redness you see is probably a hive (a localized allergic reaction). Changing the brand of insulin may help. In rare cases, someone has an allergic reaction to insulin. Speak to your diabetes team. In most cases the child eventually builds up a tolerance to the insulin and the reaction goes away.
What happens if you accidentally give too much insulin?
Believe it or not, this is not an uncommon mistake. If you’ve given too much insulin, contact your health care team. You’ll need to check your child’s blood sugar levels every 2 to 3 hours. Set your alarm to wake you up through the night if necessary. You will need to give your child extra food to prevent the blood sugar level from falling too low.
What would happen if an air bubble was accidentally injected into your child?
It’s not harmful to inject an air bubble under the skin. However, if you’re injecting air rather than insulin, your child may not be getting the full dose. This will cause a high blood sugar reading.