Children and young people with diabetes mellitus and their families often develop expertise in managing their condition independently, but their autonomy to manage it is often removed during hospital admissions. Insulin is a high-risk medicine and insulin errors can lead to serious or life-threatening events. Allowing children and their parents or carers to self-manage their diabetes and self-administer insulin while in hospital is likely to improve patient safety. In 2022-2023, the paediatric diabetes team at Southampton Children’s Hospital, England, developed and implemented a diabetes self-management policy for children and young people on insulin therapy who are admitted as inpatients. The new policy provides a robust decision-making tool for healthcare professionals and gives children and young people and their parents the opportunity to self-manage during hospital stays, if they are deemed competent and it is considered safe to do so. It is anticipated that the policy will facilitate communication between families and staff, improve patient experience and promote safe and effective diabetes management on the wards.