Aim To evaluate current practice regarding the timing of insulin administration in relation to a meal. We also evaluated the factors which could influence practice.

Method This was a prospective audit. We performed an outpatient based survey of parents or children with type 1 diabetes mellitus between November 2015 and January 2016. We produced a questionnaire based on previous studies and experience. We surveyed 47 patients/parents.

Results 55% of children were on pump therapy, while 43% were on MDI therapy. 24% of children had a HbA1c of <58 mmol/ mol and 62% of children had a HbA1c of between 58–80 mmol/ mol, (as compared with 17.8% and 58% respectively across England and Wales). Insulin was administered by children themselves in 62%, compared with 19% each in the parents and ‘both’ categories. Insulin was administered pre-meal in 70%, post meal in 19% and both pre and post in 11% of children. 86% of pre-meal insulin was administered just before a meal and the remainder (14%) within the 15 min before a meal. Post meal insulin was administered just after meal. Factors influencing the timing of insulin administration were advice from health care professionals (HCPs) (79%), habit (23%), convenience (11%), fear of hypoglycaemia (13%) and meal content (4%). 98% of children reported receiving education regarding the timing of insulin in relation to meal. 2 children (duration of diabetes 14 years and 4 years) were taking insulin post meal as advised by their HCPs at the time of diagnosis. A small number of parents had concerns regarding whether children would finish their meal, and chose to give insulin post meal.

Conclusion It is encouraging to note that 70% of children were receiving meal time insulin before meals. The most important factor influencing the timing of insulin administration is education received from HCPs, highlighting the importance of structured diabetes education at diagnosis with review and re-education during the care pathway. A small number of parents and patients reported fear of hypoglycaemia as a reason to inject insulin post meals; input from the diabetes MDT (e.g. dietitian and psychologist) may help ameliorate the actual or perceived risk.