In-Home Insulin & Diabetes Management

Why Insulin Is Not Like Other Medication

Most medication delegation is about getting the right pill to the right person at the right time. Insulin delegation is about a number that moves, and a caregiver who has to recognize when it is moving the wrong way.

• Insulin is the only injection that can be delegated. Washington permits delegation of insulin injections and prohibits every other injection. There is no middle ground to negotiate.
• The dose is not the caregiver's call. Sliding scale and correction dosing require nursing judgment. The caregiver executes the plan the RN and prescriber set.
• Errors compound fast. A missed low or a doubled dose can escalate in minutes, not hours. That is why the notification parameters matter as much as the technique.
• The caregiver has to be able to tell us what they are seeing. Not just perform the task — describe the client's condition clearly enough that we can direct them over the phone in a critical moment.
• Delegation follows the person, not the house. It is specific to one client and one caregiver, and it does not transfer to a coworker or to another client.

What We Provide

A complete delegation package, built around the specific client and the specific caregiver.

Assessment and Delegatability

• Review of the client's diagnoses, orders, and current insulin regimen
• Assessment of whether the condition is stable and predictable enough to delegate to
• Determination of which tasks can be delegated and which cannot
• A written care plan when the client is delegatable

Delegation Content

• Written instructions the caregiver will actually work from
• Step-by-step technique for injections, pump tasks, or monitoring
• Blood sugar targets and the numbers that require a call
• Signs and symptoms of hypoglycemia and hyperglycemia to report immediately
• What to document, when, and to whom

In-Person Delegation and Oversight

• A theory portion covering diabetes management from start to finish
• A practical portion with the instructions customized to this client
• An assessment of whether each caregiver can follow the instructions correctly
• Required supervision visits, on the insulin schedule
• 24-hour on-call nurse coverage, so the caregiver is never alone with a bad number

What Can Be Delegated

For a client whose condition is stable enough to delegate to, and a caregiver who holds the right credential and passes our competency check:

• Insulin injections given by the route and schedule the prescriber ordered
• Blood glucose monitoring including finger sticks and reading a continuous monitor
• Insulin pump tasks that the rules permit, delegated task by task
• Filling a pump reservoir, where the caregiver's credential allows it
• Oral diabetes medications handled alongside the rest of the medication list
• Recognizing and reporting the signs of a low or a high, per the parameters we set
• Documenting readings, doses, and anything out of the ordinary

What Cannot Be Delegated

Washington draws a clear line, and the line matters more here than almost anywhere else:

• Any injection other than insulin. Every other injection is prohibited from delegation, without exception
• Adjusting the insulin dose. Sliding scale and correction dosing require nursing judgment
• Deciding what to do about a reading. The caregiver reports; the nurse or prescriber directs
• Clients whose condition is not stable. Frequent changes mean more nursing, not less
• Filling a medication organizer. This is not delegable to a CNA or home care aide in Washington, in a private home as well as a facility
• Transferring a delegation. One client, one caregiver. A coworker needs their own

If a client cannot be delegated to, or a caregiver cannot follow the instructions safely, we will tell you plainly. Insulin does not leave much margin.