Families arranging home care for someone with diabetes usually get one thing wrong at the start. They assume that if a carer can give tablets, a carer can give insulin. They can’t — not without a specific, documented process most people have never heard of.
Getting this right before care starts saves a great deal of trouble. This guide covers what a home carer is and isn’t allowed to do, how district nursing fits in, how to recognise and treat a hypo, and the everyday things — meals, feet, illness — that decide whether someone stays well at home.
Who does what
| Task | Who |
|---|---|
| Prompting and reminding about tablets or testing | Trained care worker |
| Giving oral diabetes medication from a dispensed system, and recording it | Trained care worker |
| Meals and drinks at consistent times; recording what was eaten | Trained care worker |
| Washing and drying feet, checking them, applying prescribed cream | Trained care worker |
| Recognising and treating a hypo, then escalating | Trained care worker |
| Supporting someone to do their own injection | Trained care worker |
| Administering insulin | Only a carer with written, person-specific delegation — otherwise the district nurse |
| Blood glucose monitoring | Usually a delegated task; carers report readings, never adjust doses |
| Adjusting any dose | District nurse, diabetes specialist nurse or GP |
| Cutting toenails, treating corns or callus | Podiatrist only |
| Wounds, ulcers and dressings | District nurse |
Why insulin is different
Administering insulin, and in many services taking a blood glucose reading a clinical decision rests on, are delegated clinical tasks. They are not part of general care training.
Diabetes UK, with NHS England, publishes a framework for delegating insulin administration to non-registered care workers. It exists because there was no consistent route, and people were waiting for a district nurse twice a day for an injection a trained carer could safely give. In broad terms:
- A registered nurse — usually the district nurse or diabetes specialist nurse — assesses that the person is stable and cannot self-administer.
- The care worker is trained and then competency-assessed against a written framework, not just told what to do.
- The delegation is person-specific and in writing. A carer signed off for Mrs A is not thereby signed off for Mr B, or for a different insulin or device.
- The provider organisation must have the policy, checklists and indemnity in place first.
- The delegating nurse keeps accountability and reviews it. It is not a hand-off and walk away.
- Dose adjustment stays clinical. A carer gives the prescribed dose and does not decide to give more or less because a reading looks high or low — that goes back to the nurse or GP.
Not every provider does this, and not every area’s NHS service operates a delegation scheme. Some people are on insulin too variable for delegation to be appropriate. Where delegation isn’t in place, insulin is given by the community nursing team, arranged through the GP — free, but at times that suit the round rather than the meal.
The question to ask an agency is precise: do you have a written insulin delegation agreement with the local NHS service, and are the specific carers who would come here competency-assessed for this person? A vague “our staff are medication trained” is not an answer. See how to choose a home care agency and medication management at home.
Where the district nurse comes in
District nurses are free on the NHS and referred through the GP. They give insulin where delegation isn’t possible, manage foot ulcers and wounds, oversee delegation and competency where it is, and review anything unstable. They won’t do personal care or meals — that is the home care provider’s job. Most arrangements that work well are a mix of the two.
Hypos: the emergency everyone should be able to handle
Hypoglycaemia — blood glucose falling too low — is the acute risk in anyone on insulin or on sulfonylurea tablets such as gliclazide. In the UK, below 4 mmol/L is the standard threshold; the phrase clinicians use is “four is the floor”.
Signs: shaking, sweating, going pale, hunger, tingling lips, palpitations, anxiety or irritability, blurred vision, confusion, slurred speech, unsteadiness. In older people a hypo often looks like confusion or a fall rather than the classic sweating, which is why it gets mistaken for dementia or “a funny turn”. Some people who have had diabetes a long time lose the early warning signs altogether — flag that to the diabetes team, because it changes the whole risk picture for someone living alone.
If the person is conscious and can swallow, the NHS approach is:
- Give fast-acting sugar straight away — a small glass of fruit juice or sugary (non-diet) fizzy drink, glucose tablets, glucose gel or jelly babies. Roughly 15–20g of fast carbohydrate.
- Wait 10–15 minutes, then retest if a meter is available.
- If still low, repeat the fast-acting sugar and recheck.
- Once recovered, give longer-acting carbohydrate — a sandwich, a couple of biscuits, or the next meal if due.
If the person is unconscious, fitting or cannot swallow safely: put nothing in their mouth, use the recovery position and call 999. Glucagon may be given if prescribed and someone present is trained. Call 999 too if glucagon isn’t available or hasn’t worked within about 10 minutes, or if alcohol is involved.
Chocolate is a poor hypo treatment — the fat slows the sugar down. Keep supplies where a carer can find them without hunting. Every hypo needing help from someone else should be reported to the GP or diabetes team, because it usually means the medication needs adjusting.
Regular eating matters more than perfect eating
For someone on insulin or sulfonylureas, missing a meal is not a small thing. The medicine still acts. A skipped lunch is a hypo in a few hours. This is where home care earns its cost, and where 15-minute calls fall down.
- Keep meal timing roughly consistent, particularly in relation to injections.
- Record what was actually eaten, not what was made. A plate left untouched is clinical information.
- Watch appetite loss. Common in older people, and with unchanged medication it is a direct route to hypos and weight loss.
- Don’t over-restrict. Strict dieting in a frail older person often does more harm than a slightly higher reading. NHS advice is a normal balanced diet — vegetables, wholegrains, pulses, less processed food. Targets are loosened for many older people; ask what this person’s target actually is.
- Keep fluids up. High glucose causes dehydration, which causes confusion and falls.
Where the difficulty is shopping and cooking rather than personal care, domestic care or home help may be all that’s needed.
Feet: small problem, serious consequence
Diabetes damages nerves and circulation, so a foot can be badly injured without hurting, and heals slowly. That is why diabetic foot problems end in amputation far more often than they should — not because the wound was dramatic, but because nobody saw it.
- Feet checked daily, including between the toes and the soles. If the person can’t see or reach their feet, this becomes a carer task and belongs in the care plan explicitly.
- An annual NHS foot check — everyone with diabetes is entitled to one. Circulation and sensation are tested and a risk level assigned; moderate or high risk means referral to podiatry.
- Podiatry, not DIY. Carers should not cut toenails or treat corns and callus in someone with diabetes. Washing, drying carefully between the toes and applying prescribed cream are fine.
- Shoes checked for stones, seams and rough edges before they go on. Never barefoot.
Contact the GP or diabetes team the same day for: a break in the skin that isn’t healing, redness or swelling, a change in colour, a hot or unusually cold foot, discharge or smell, or new numbness. Do not wait for a routine appointment.
Sick day rules
Illness raises blood glucose even when someone isn’t eating, and it is when things go wrong quickly. The broad principles — get the person’s own written version from their diabetes team, because details differ by medication:
- Never stop insulin because the person isn’t eating. The dose may need to go up, not down.
- Some tablets are paused during significant illness, dehydration, vomiting or diarrhoea — metformin and SGLT2 inhibitors among them. This is the part that gets missed, and why a written personal plan matters.
- Test more often, check ketones if the person has been told to (mainly type 1), and keep fluids going in small amounts, frequently.
- Get help early for persistent vomiting, readings staying very high, ketones, drowsiness, rapid breathing or breath smelling of pear drops. That is a 999 or urgent GP call, not wait-and-see.
Older people with diabetes also get infections more readily and present atypically — confusion or a fall rather than a fever. Read this alongside care after hospital discharge, since a diabetes admission often ends in a step-up of support.
What to have written in the care plan
Before care starts, insist these are on paper and in the home:
- Every diabetes medicine, dose and time — and who gives each one (carer, district nurse, the person themselves)
- Whether insulin is delegated, to whom, and the date of competency assessment
- Whether blood glucose is monitored, by whom, when, and what readings to report
- This person’s target range, their usual hypo signs, and where hypo treatment is kept
- Whether glucagon is prescribed and who is trained to give it
- Meal times, and what to record about what was eaten
- Foot care: who checks, how often, who to ring about a wound
- The sick day plan from the diabetes team, and named contacts — GP, district nursing team, diabetes specialist nurse, podiatry
Funding and local support
NHS care — GP, district nurses, podiatry, diabetes specialist nurses, structured education — is free. Social care is means-tested. Start with a free care needs assessment from West Sussex County Council; anyone who appears to need care can have one regardless of savings.
England 2026/27 capital thresholds: above £23,250 you self-fund, £14,250–£23,250 you contribute, below £14,250 capital is disregarded. For care at home the person’s property is not counted. Attendance Allowance is £76.70 or £114.60 a week and is not means-tested — supervision needed because of hypo risk counts. Expect £28–£38 an hour in West Sussex; see home care costs and funding in West Sussex.
Diabetes UK runs a helpline and local groups, with the clearest plain-English guidance on hypos, feet and sick day rules. Carers Support West Sussex supports family carers — including with the low-level dread of being the person responsible for spotting a hypo.
Frequently asked questions
Can a home carer give insulin?
Only under a formal delegation. A registered nurse must assess that the person is stable and unable to self-administer, the carer must be trained and competency-assessed against a written framework, and the delegation is person-specific and documented. Where that isn’t in place, the district nursing team gives insulin. Ask the agency directly whether they operate a delegation agreement.
Can carers check blood sugar?
Trained carers can often take readings, but it is a delegated clinical task in most services and comes with the same training and competency requirements. Crucially, carers record and report readings — they do not adjust doses. Any decision to change a dose belongs to the district nurse, diabetes nurse or GP.
What should a carer do if someone has a hypo?
If the person is conscious and can swallow, give fast-acting sugar such as juice, a sugary drink, glucose tablets or gel, wait 10–15 minutes, retest and repeat if still below 4 mmol/L, then give longer-acting carbohydrate like a sandwich. If they are unconscious or fitting, give nothing by mouth, use the recovery position and call 999.
Why can’t a carer cut toenails for someone with diabetes?
Nerve damage means a small cut may not be felt, and poor circulation means it heals slowly and can become a serious ulcer. Nail cutting and treating corns or callus are podiatry tasks. Carers should wash feet, dry between the toes, apply prescribed cream, check daily for breaks in the skin and report changes the same day.
Does diabetes qualify for Attendance Allowance?
It can. The benefit is based on the help or supervision someone needs, not the diagnosis. Needing prompting with medication, help with meals and injections, foot checks, or supervision because of hypo risk all count. It is £76.70 or £114.60 a week in 2026/27, is not means-tested, and savings and income do not affect it.
The Care Panel is an independent publication. We are not a care provider and are not regulated by the Care Quality Commission, because we do not deliver care. Always check a provider’s own CQC registration and inspection report before you commit.
Written and fact-checked by The Care Panel. Last updated September 2026. Sources: NHS guidance on hypoglycaemia and type 2 diabetes, Diabetes UK resources on delegation of insulin administration and the annual foot check, NICE diabetes guidance, and gov.uk for benefit rates. General information, not medical advice.