Insulin: supporting safe self-administration in vulnerable patient groups in the community

Background

Diabetes is one of the most common chronic diseases in England and the number of people with the condition is on the increase. It is a condition where blood glucose levels are too high due to various factors, including problems with the pancreas (which produces insulin). People with diabetes require their blood glucose levels to be monitored and to be maintained within a specified range. Where blood glucose levels are not maintained adequately, short-term and long-term problems can arise for the person which can be life-threatening.

In many people, management of diabetes involves the administration of insulin. Insulin can be administered in various ways including via a needle and syringe, pen device or pump.

This investigation explores risks to patient safety for patients in the community who self-administer insulin and who may be at increased risk of harm because of their circumstances.

We have also completed an investigation to examine risks to patient safety when patients who take insulin are admitted to acute hospitals.

Summary of investigation

Evidence suggests that several different patient groups are at risk of insulin-related harm. Some of these groups are particularly vulnerable, with multiple interacting factors that influence their care. We identified that an investigation may offer most learning by focusing on insulin-related harm to people with mental health diagnoses at risk of suicide, people with a disability and people with a learning disability.

For each of these groups the investigation considers:

What are the processes involved in the care of people who self-administer insulin in community settings?
How do people access support for their insulin at the point of dispensing and administration?
How do people access support in the monitoring of their condition and insulin use over time?

Investigation reports

To date we have published two reports:

Two further reports covering older people with memory difficulties and people with a learning disability will be published later in 2026.

Publications

Investigation report: Patients with a mental health problem

Investigation report: Patients with a disability

Timeline

28 May 2025

Notification of investigation

26 February 2026

'Insulin: supporting safe self-administration for patients in the community with a mental health problem' report published

19 May 2026

Insulin: supporting safe self-administration for patients in the community with a disability' report published

Safety recommendations

NHS England |

Department of Health and Social Care

HSSIB recommends that NHS England/Department of Health and Social Care develops a strategy for improving collaboration between mental health teams and specialist diabetes services, that includes consideration of responsibilities for integrated working at national, regional and local levels. This is to support future integration of services that will benefit all patients with mental health and diabetes care needs, including patients who are required to self-administer insulin and patients with type 1 diabetes and disordered eating.

National Institute for Health and Care Research

HSSIB recommends that the National Institute for Health and Care Research, in collaboration with relevant research and policy stakeholders:

maps the knowledge gaps surrounding type 1 diabetes and disordered eating (including those identified in this investigation); and
assesses the priority and feasibility of commissioning research to help address those gaps.

This is to help develop new knowledge to inform future decisions for the delivery of safe and effective care for this group of patients.

Royal College of Psychiatrists

HSSIB recommends that Royal College of Psychiatrists, through collaboration with relevant stakeholders, develops a strategy that:

supports consistent recognition of patients with type 1 diabetes and evidence of disordered eating; and
identifies associated care responsibilities for providers of mental and physical health services.

This is to help improve the NHS’s recognition of patients who are affected and to support decisions around the commissioning of services.

NHS England |

Department of Health and Social Care

HSSIB recommends that NHS England/Department of Health and Social Care provides guidance to integrated care boards and community providers setting out expectations for service models that empower and support people to manage and administer insulin in community settings. This is to support recognition of models that have safely, effectively and equitably engaged patients, their families and carers, including through the use of modern diabetes technology for self-management.

NHS England |

Department of Health and Social Care

HSSIB recommends that NHS England/Department of Health and Social Care develops a tool for use in community settings to support the assessment of competency of patients, their families and carers to manage and administer insulin and care for people with diabetes. This should include recognition of a person’s circumstances, the impact of disabilities and impairments, and potential adjustments to support administration where safe to do so. This is to support consistency in how competency is assessed for the safe management of insulin within the context of modern diabetes care.

Safety observations

HSSIB makes the following safety observations:

Organisations involved in the provision of undergraduate and pre-registration education and preceptorship/induction programmes can improve patient safety by ensuring that staff have knowledge of diabetes, an understanding of how and why insulin is a vital treatment for many people with diabetes, and the risks that the use and misuse of insulin can present for patients with a mental health problem.

Organisations involved in the manufacture of insulin pen devices used by the NHS can improve patient safety by:

understanding where devices are being used outside of their intended purpose; and
exploring the potential to design devices that would reduce the risk of intentional overdose of insulin for self-harm.

National bodies can improve patient safety by providing clarity on expectations around 1) how staff recognise that a patient’s mental capacity may be compromised in relation to decisions about their self-management of insulin, and 2) the undertaking of a mental capacity assessment by the most appropriate person. This should include clarification on the practical application of the Mental Capacity Act (2005) to situations where a patient’s capacity may fluctuate and where sharing confidential information to support patient safety may be appropriate.

Insulin: supporting safe self-administration in vulnerable patient groups in the community

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Background

Summary of investigation

Investigation reports

Publications

Downloads

Safety recommendations

NHS England |

Department of Health and Social Care

National Institute for Health and Care Research

Royal College of Psychiatrists

NHS England |

Department of Health and Social Care

NHS England |

Department of Health and Social Care

Safety observations