Insulin: supporting safe self-administration in vulnerable patient groups in the community
Published
Mental health
Medication
Learning disabilities
This series of reports 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. To date we've published two out of four reports.
5 recommendations
3 observations
Safety Recommendations (5)
NHS England
R/2026/073
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 Excellence
R/2026/074
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
R/2026/075
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
R/2026/084
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
R/2026/085
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 (3)
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:
1) understanding where devices are being used outside of their intended purpose; and
2) exploring the potential to design devices that would reduce the risk of intentional overdose of insulin for self-harm.
HSSIB suggests safety learning for integrated care boards
HSSIB investigations include safety learning for integrated care boards where this may support the response to a patient safety issue across a geographical footprint.
Safety learning for integrated care boards ICB/2026/014:
HSSIB suggests that integrated care boards formalise collaborations between mental health and specialist diabetes services in their local systems. Through co-production with people with lived experience, this should look to include:
care arrangements for people with a mental health problem and diabetes, particularly for those who require insulin
routes for community mental health teams to access advice where their patients have diabetes and access to insulin
routes for diabetes specialist teams to seek advice from mental health teams about reasonable adjustments for patients under the care of outpatient clinics
enablement of interoperability between electronic systems to support information sharing.
Safety learning for integrated care boards ICB/2026/015:
HSSIB suggests that integrated care boards develop data-driven approaches for the understanding of local need to inform decisions about services for patients who have been identified as marginalised in this investigation. These are patients with:
1) co-existing mental health and long-term physical health needs (diabetes), including those with a diagnosed personality disorder and/or experiencing homelessness; and
2) type 1 diabetes and disordered eating.
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.
HSSIB suggests safety learning for integrated care boards
HSSIB investigations include safety learning for integrated care boards where this may help organisations think about how to respond to a patient safety issue that relates to integrated care across a geographical footprint. Informed by the findings in this report, the investigation proposes the following safety learning.
Safety learning for integrated care boards ICB/2026/017:
HSSIB suggests that integrated care boards develop data-driven approaches to effectively identify the diversity of their populations’ characteristics and social circumstances, and use this data to support community providers to design services that empower and enable people to be involved in a patient’s care, including through supporting self-management of medications and conditions.
Safety learning for integrated care boards ICB/2026/018:
HSSIB suggests that integrated care boards, through future planning for neighbourhood health services, include consideration of how patients who may be at greater risk of harm from insulin administration due to their specific circumstances – for example co-existing disabilities, social isolation or receiving home-delivered medications – are proactively monitored to identify changes in their circumstances. This may include using technology such as remote monitoring.