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Risks to patients with diabetes requiring insulin during hospital admissions in England — including cases where patients have come to harm or died when their condition was not appropriately managed — have been identified in a report published by the Health Services Safety and Investigations Body (HSSIB).
In the report, ‘Insulin: supporting safe administration in inpatient settings’, published on 26 March 2026, the HSSIB has examined the management of diabetes care and the safe use of insulin in hospital.
The report said insulin is a “high-risk medication” and one of the most common causes of harm from medication errors in the NHS.
It added that “going into hospital can create risks for patients with diabetes”, and that harm has occurred when diabetes requiring treatment with insulin has not been managed appropriately.
According to NHS England data, diabetes affects more than 3 million people in England, and the HSSIB report has estimated that the prevalence of diabetes will rise to 4.2 million people by 2030.
HSSIB also found that oversight of inpatient diabetes care is “fragmented”, with responsibility for patient safety largely devolved to individual NHS trusts, which can lead to “gaps in responsibility and accountability” for implementing national guidance and acting on audit data.
The report also noted that regulatory activity relating to in-patient diabetes care “requires strengthening”, and that local governance structures recommended in national guidance – such as diabetes safety boards – are “often absent”.
In addition, it said that prioritisation and funding of inpatient diabetes care at both trust and integrated care board (ICB) level “has not supported the full implementation of national guidance and recommendations”.
Commenting on the report, Hannah Beba, consultant pharmacist for diabetes at West Yorkshire Health and Care Partnership, said: “Insulin remains a high‑alert medicine with a persistently high burden of avoidable harm in inpatient care, and this report rightly highlights risks spanning reconciliation, prescribing, administration, monitoring and peri‑operative management.
“From a pharmacy perspective, the findings reinforce the need for standardised insulin order sets, clear protocols for self‑administration, robust education and competency frameworks for all staff handling insulin, and better use of electronic systems to reduce omission and timing errors.
“They also strengthen the case for embedding specialist diabetes pharmacists within multidisciplinary inpatient teams, to lead guideline implementation, support complex decision‑making and drive continuous improvement in insulin safety across organisations.”
The report also highlighted workforce and training issues. It found that most inpatient diabetes care is delivered by non-specialist staff who “may lack confidence and/or competence” in diabetes management.
Diabetes and insulin training for non-specialist staff and students was described as “inconsistent”, with “no national minimum mandated standard” for education, training or competency assessment, the report added.
According to the report, specialist diabetes teams were reported to be “often under-resourced” and not always able to provide seven-day services or support all patients who may need input.
Esther Walden, senior clinical advisor at Diabetes UK, said: “Many people with diabetes tell us their fears of being admitted to hospital. This report confirms that despite some progress, unacceptable variations in care continue to put people using insulin at risk.
“Pharmacy teams have a pivotal role to play in improving safety and should be an integral part of hospital diabetes safety boards. Supporting insulin education for non-specialist ward staff, improving safety through daily reviews of insulin charts and analysing insulin medication error data are just some ways hospital pharmacy staff can help.
“Hospitals should have clear policies, strong leadership and the right systems in place to ensure best practice is consistently applied, so that inpatients with diabetes no longer face avoidable harm.”
The report also found that some patients who safely self-administer insulin at home are prevented from doing so in hospital, which was linked to local policies and “reluctance of staff” owing to concerns about accountability if incidents occur.
It also noted a “lack of clarity” around bedside storage of insulin, which can act as a barrier to self-administration.
The report made several recommendations, including that NHS England and the Department of Health and Social Care set out clearer expectations for oversight and accountability across trusts and ICBs.
The Royal College of Physicians should review research and data on adding blood glucose monitoring to the national early warning score, while the Care Quality Commission should consider how it uses national diabetes data in its regulatory activity, it recommended.
For ICBs, the report said they should consider its findings when making funding decisions, particularly to support “appropriately staffed seven-day inpatient diabetes specialist services”.
