[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Medical–surgical nursing](https://durgical.com/en/nursing/areas/med-surg/) › Giving insulin safely: types by action, pens and syringes, sites, rotation and storage

# Giving insulin safely: types by action, pens and syringes, sites, rotation and storage

- Procedure

Insulin is a high-alert medicine: the nurse checks the glucose, the product and the meal before every injection and rotates the sites.

Updated Nov 13, 2026

## Key points

- Before every dose: current glucose, symptoms of a low, the meal arriving and the right product; tell the patient the value and the insulin.
- Only regular (short-acting) insulin may be given IV, with close glucose and potassium monitoring; long-acting and NPH are for subcutaneous use only.
- One pen, one patient: a pen is never shared, even with a new needle.
- Rotate sites within the same region: repeated injections in one spot cause lumps or dents (lipodystrophy).
- Insulin should be clear and colourless, except NPH (cloudy); discard it if it has particles or an unusual colour.
- Mixing in one syringe: clear (rapid or short-acting) is drawn first, then NPH.

On this page

- The basics Key points
- What it is
- Indications
- Equipment
- Step by step (and why)
- Next step: when to call for help
- Elsewhere in DurgiPedia

- Clinical Complications

- Safety Contraindications and precautions

- Study Test yourself

- Connections Connections

## What it is

Insulin is given under the skin with a pen or a syringe. Types are grouped by how fast they start and how long they last: rapid-acting and short-acting insulins cover meals; intermediate-acting (NPH, the only cloudy one) and long-acting insulins cover the basal need; premixed insulins combine two types. Insulin is a high-alert medicine: wrong product, wrong amount, a missed dose, the wrong route or poor monitoring can cause severe harm. This page covers the checks that are specific to insulin; the general subcutaneous technique is on the subcutaneous injection page. The amount and the timing always come from the order and the institutional protocol.

## Indications

- Ordered subcutaneous insulin: basal, prandial (with meals) and correction doses, as the order specifies.
- Rapid-acting: starts within minutes and is given just before or right after a meal; short-acting (regular): given about half an hour before the meal.
- Intermediate-acting (NPH): cloudy suspension, once or twice a day; long-acting: no pronounced peak, usually once a day.
- Premixed insulins (intermediate plus rapid or short-acting) are given before meals and are not mixed with other insulins.

## Contraindications and precautions

- Do not give a dose if the patient has hypoglycaemia or symptoms of one: treat it with the protocol and tell the doctor.
- If the patient cannot eat, is fasting or has vomited, confirm the order before a prandial dose.
- Insulin shifts potassium into the cells: check potassium in patients at risk, for example those on diuretics.
- Independent double check when the institution requires it; never give insulin IM by mistake.
- Pens and vials are labelled for one patient; a vial is always entered with a new needle and syringe.

## Equipment

- The order and the medication record; the barcode scanner if available.
- The patient's labelled pen with a new pen needle, or the vial and an insulin syringe.
- Glucose meter or the most recent glucose result; gloves and alcohol swabs.
- Sharps container at the point of use.

## Step by step (and why)

- Verify the order and the rights, and identify the patient with two identifiers (and barcode): look-alike products and names cause errors.
- Check the current glucose and ask about symptoms of a low: never give insulin without a current value.
- Confirm the meal is there and the patient can eat before a prandial dose: insulin without food causes hypoglycaemia.
- Check product, patient label, open date and appearance; gently roll or invert NPH: an uneven suspension changes the dose.
- If mixing in a syringe, draw the clear insulin first, then NPH; do an independent double check if required.
- Tell the patient the glucose value, the insulin and its action: the patient is a last safety check and learns the regimen.
- Choose a site in the abdomen, thigh or upper arm and move away from the last spot within the same region: rotation prevents lipodystrophy.
- Inject under the skin; with a pen, count to at least five before withdrawing the needle: the full dose is delivered.
- Discard the needle at once in the sharps container at the point of use: this prevents needlestick injuries.
- Record dose, site and time, and watch for a low around the expected peak of that insulin.

## Complications

- Hypoglycaemia: the most frequent and dangerous complication; risk is higher in older adults and with beta-blockers, which can hide the signs.
- Lipodystrophy (lumps or dents) at overused sites, which also makes absorption unpredictable.
- Hypokalaemia, especially with IV insulin.
- Bloodborne infection if a pen or a needle is shared; errors from wrong product, omitted dose or wrong route.

## Next step: when to call for help

- Call at once if the glucose is below the protocol threshold or the patient has signs of a low after insulin.
- Report before giving the dose if the patient cannot eat, is fasting, is vomiting or the glucose is very high.
- Report any insulin error (wrong product, amount, patient or route) immediately and follow the adverse-event process.
- Storage: unopened vials and pens are refrigerated until expiry; once opened, label the date and discard after the period set for that product.

## Test yourself

Think of the answer, then tap the question to see it.

## Which insulin is cloudy and must be gently rolled before use?

Intermediate-acting NPH insulin. The others should be clear and colourless; any insulin with particles or an unusual colour is not used.

## When mixing a rapid-acting insulin with NPH in one syringe, which one is drawn first?

The clear insulin (rapid or short-acting) first, then the cloudy NPH. Premixed insulins and some other products are not mixed.

## Why must an insulin pen never be shared between patients, even with a new needle?

Blood can flow back into the cartridge after an injection, so a shared pen can transmit bloodborne infections. One pen is for one patient.

## What does the nurse check right before a prandial insulin dose?

The current glucose, symptoms of a low, that the meal has arrived and the patient can eat, the order, the product and the patient's identity.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/giving-insulin-safely-types-by-action-pens-and-syringes-sites-rotation-and-stora/)

## Elsewhere in DurgiPedia

- [Islets and insulin: secretion and actions](https://durgical.com/en/physiology/islets-and-insulin-secretion-and-actions/)

## Connections

## Related 5

- [Subcutaneous injection](https://durgical.com/en/nursing/subcutaneous-injection/)
- [High-alert medications](https://durgical.com/en/nursing/high-alert-medications/)
- [The rights of medication administration](https://durgical.com/en/nursing/the-rights-of-medication-administration/)
- [Capillary blood glucose testing](https://durgical.com/en/nursing/capillary-blood-glucose-testing/)
- [Hypoglycaemia: recognising it and the nursing response, conscious and unconscious](https://durgical.com/en/nursing/hypoglycaemia-recognising-it-and-the-nursing-response-conscious-and-unconscious/)

## Related conditions 2

- [Type 1 diabetes mellitus](https://durgical.com/en/conditions/type-1-diabetes-mellitus/)
- [Type 2 diabetes mellitus](https://durgical.com/en/conditions/type-2-diabetes-mellitus/)

## In Pharmacology 1

- [Insulins](https://durgical.com/en/pharmacology/classes/insulins/)

[← All of nursing](https://durgical.com/en/nursing/)

Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: [Nursing Pharmacology, 9.4: Antidiabetics](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Pharmacology_(OpenRN)/09%3A_Endocrine/9.04%3A_Antidiabetics) (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2023); [Considerations for Blood Glucose Monitoring and Insulin Administration](https://www.cdc.gov/injection-safety/hcp/infection-control/index.html) (Centers for Disease Control and Prevention (CDC), 2024); [16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2025](https://pmc.ncbi.nlm.nih.gov/articles/PMC11635037/) (American Diabetes Association Professional Practice Committee, Diabetes Care (PMC), 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/nursing/giving-insulin-safely-types-by-action-pens-and-syringes-sites-rotation-and-stora/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/giving-insulin-safely-types-by-action-pens-and-syringes-sites-rotation-and-stora/