Insulin at home: who can give it and how carers fit in

If you are not sure which kind of diabetes your relative has, or why they are on insulin rather than tablets, what diabetes is and how it is treated covers the basics. The NHS says type 2 diabetes is treated first with changes to eating and activity, then tablets, and for some people insulin, so a parent who has managed on tablets for years can find themselves learning injections later in life.

The line in the middle of the table is the one national guidance draws. The Care Quality Commission separates prompting, which means reminding somebody that a dose is due and leaving them to take it, from administering, which means selecting the dose and giving it. A carer can prompt as part of an ordinary visit. Where specific skills are needed to give a medicine, NICE guideline NG67 says a health professional should only delegate it to a care worker when there is local agreement, your relative has consented, everybody's responsibilities are agreed and recorded, and the care worker has been trained and assessed as competent. NICE also names insulin as a time-sensitive medicine, where a late or missed dose can cause serious harm.

What sits on the "Yes" side of the line is a good deal of help. A carer who arrives at the time the insulin is usually taken can make sure the pen is found, the meal that goes with it is cooked and eaten, and the dose your relative gives themselves is written down. They can notice a meal left uneaten or spare pens running low, and tell you or the nurse. If your relative needs that kind of help every day around insulin times, you can search for carers near you and compare their rates, and ask each one at interview what they have done before with diabetes and whether they have ever had a task delegated to them. What a carer says about their experience is their own account on their profile, so ask about it and check what matters to you. Every carer on PrimeCarers has had their identity and right to work checked, has an enhanced DBS check (or PVG in Scotland, Access NI in Northern Ireland) issued within the last 2 years, and has been interviewed online. Carers are insured while they work.

1. 1

   Ask the district nursing team whether they delegate insulin

   The first conversation

   The framework is voluntary, and each area decides whether it uses it. Some teams delegate to care workers employed by a home care provider, and some do not delegate at all. Ask before you plan around it.
2. 2

   The nurse decides whether your relative is suitable

   A clinical judgement

   The framework is for adults who cannot give their own insulin and whose diabetes is stable, using a pen rather than a syringe. The nurse judges this, and your relative has to agree to somebody else giving it.
3. 3

   The nurse trains and assesses one named carer

   Before the first injection

   The national materials combine an online course with supervised practice and a competency workbook the nurse signs off. The training is for that carer, with your relative's pen, and it does not pass to anyone else.
4. 4

   It is written down

   A letter and the care plan

   The framework includes a letter of delegation. NHS England guidance says the care plan should state the task being delegated and its limits, how risks are managed, and how often the arrangement is reviewed.
5. 5

   Insurance is checked, and the nurse stays involved

   Before it starts, then reviewed

   NHS England expects whoever arranges the care to check that insurance covers the delegated task. The nurse keeps the clinical oversight and reviews the carer's competence on the timetable in the plan.

One practical consequence matters more than the rest. Because the delegation is to a named person, it does not travel with them. If that carer is off sick or sends somebody else in their place, the replacement cannot give the insulin unless the nurse has trained and signed them off too. Agree with the nurse in advance who gives it on those days. Our guide to delegated healthcare tasks explains who stays accountable for what once a task has been handed over.

The other thing worth keeping by the insulin is a note of exactly which insulin your relative uses, by name and by device. The NHS booklet "The safe use of insulin and you" warns that several insulins have similar names and packaging, and asks people to carry an insulin card showing the right one. Some diabetes teams give out an insulin passport for the same purpose, so ask whether yours does. If your relative goes into hospital, the card or passport goes with them.

Full sharps bins are handled differently from one area to another. Some councils collect them, sometimes for a charge, and some ask for a form from a health professional first. Some pharmacies and GP surgeries take them back. Ask the pharmacy when you collect the first bin, or use the gov.uk service to find out whether your council collects clinical waste.

The record works best as part of a fuller written plan that lives in the house, with the GP practice, the diabetes team, the pharmacy and the family's numbers in one place. A diabetes care plan for home sets out what to put in it.

Carers UK suggests writing an emergency plan for this situation, listing the medicines, the GP and the people to ring, and sharing it with family and professionals. Some areas run carers' emergency card schemes, and Carers UK says every carer who has a carer's assessment should be asked about emergencies and offered help to plan for them. Its page on getting help in an emergency explains what a plan covers.

While the nurse gives the insulin, a carer coming in for meals, the record and an eye out for hypos keeps the rest of the day steady. Arranging care to cover a holiday explains how families plan cover for a week or two.