Diabetes Care Tasks at Diabetes Care Tasks at School:School:

What Key Personnel What Key Personnel Need to KnowNeed to Know

Diabetes Care Tasks at Diabetes Care Tasks at School:School:

What Key Personnel What Key Personnel Need to KnowNeed to Know

INSULIN ADMINISTRATIONINSULIN ADMINISTRATION

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Overall Goal: Student Health and Learning

Following the insulin regimen is critical to student success.But just one piece of a comprehensive management plan.

Exercise

LegalRights

Health&

Learning

Nutrition

InsulinAdministratio

n

Hypoglycemia &

Hyperglycemia

Ketones

Monitoring

Blood Glucose

Glucagon Administrati

on

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Participants will learn: Types of insulin Insulin delivery basics Vial and syringe administration Pen device administration Pump basics

Learning Objectives

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Insulin in Schools Today

Many students need to take insulin in school.

Insulin regimens vary with each student and over time.

Need for assistance will vary as the student progresses in self-management.

GOAL: Maintenance of blood glucose target range.

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Insulin Types Rapid-acting - Humalog ®, Novolog ® Short-acting - Regular Intermediate - Lente, NPH Long-acting - Ultralente, Glargine (Lantus)

Storage: Refrigeration or store at temperature less than 86

degrees as specified by DMMP. Refrigerate unopened vials and insulin pens.

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Basal Insulin

Prandial BolusesIn

suli

n

0hr 24hr

BG

mg

/dl

Physiologic Insulin Therapy

Jameson:

I inserted this to help explain basal/bolus therapy and the goals of insulin replacment..

Jameson:

I inserted this to help explain basal/bolus therapy and the goals of insulin replacment..

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Time Activity of Human Insulins

Jameson:

Not the best picture but it helps the visual learner.

Jameson:

Not the best picture but it helps the visual learner.

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Delivery Methods

Insulin Syringe

Insulin Pen

Insulin Pump

Jet Injector

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When to Give InsulinAdminister as specified by DMMP:

Generally: Before meals or snacks. For blood glucose levels significantly above

target range. For moderate, large, or increasing ketones,

as per DMMP.

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Dosing

For many students, insulin dose varies, depending upon:Blood glucose readingsFood availability/preferencePhysical activity levelAge/body weight

Follow prescribed guideline in DMMP.

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Dosage Specifications

DMMP should specify conditions clearly. Dosage based upon insulin to carbohydrate

ratios for meals and snacks. Correction dosage to treat hyperglycemia.

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Insulin Bolus Dosage Amount to “cover” food eaten

- Usually calculated as 1 unit per x number gms of carbohydrate - For example: 6 units needed to cover 60 gms CHO if using 1 unit per 10

gms CHO (60/10 = 6) Amount to lower blood sugar to target range

- Usually calculated according to sliding scale or correction factor- Sliding scale: give units of insulin for each range of BG indicated on

DMMP- Correction factor: Blood glucose level – target blood glucose/correction

factor = units insulin to be given- Ex: BG=150 (actual) minus Target BG (100) = 50 divided by Correction

factor (50) = 1 unit insulin needed Add together to get Insulin Bolus Dosage

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Insulin Syringes

Sizes – 30, 50, 100 units

Disposal-

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Syringe & Vial: Preparation

1. Get Supplies Insulin (Verify) Syringe Alcohol wipe Disposable gloves Sharps container

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Syringe & Vial: Preparation2. Wash hands; apply

gloves

3. Clean the insulin vial

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Syringe & Vial: Preparation

4. Have student select injection site.

5. Clean the injection site

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Syringe & Vial: Preparation

6. Check the insulin dose

7. Remove the cap from syringe.

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Syringe & Vial: Dosing

8. Pull the plunger down to number of units to be administered.

9. Inject air into bottle.

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Check Dose10. Draw out prescribed number of units of insulin as per DMMP.

Syringe & Vial: Dosing

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Syringe & Vial: Injecting11. Pinch up the skin.12. Push needle into skin at 90. 13. Release pinch.14. Push the plunger in.15. Count to “5”.16. Remove needle and dispose

of syringe.17. Document time, dosage,

site, and blood glucose value.

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On Target!

Jameson:

I think the purpose is obvious.

Jameson:

I think the purpose is obvious.

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Insulin Pen: Devices

Prefilled pens

Reusable (cartridge) pens

Techniques for dose preparation and insulin delivery are similar for both types of pen devices.

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Insulin Pen: Preparation

1. Gather supplies. Verify insulin type. pen device (with cartridge) pen needle alcohol wipe sharps container

2. Wash hands.

3. Chose injection site

4. Clean injection site

5. Screw on pen needle

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Insulin Pen: Dosing

6. Prime: Dial “2” units.

7. Hold upright. Remove air by pressing the plunger. Repeat “Prime” if no insulin shows at end of needle.

8. Dial number of units to be administered as per DMMP.

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Insulin Pen: Injecting9. Choose and clean injection site.

10. Pinch up the skin.

11. Push the needle into the skin at 90 12. Release pinched skin.

13. Push down on the plunger.

14. Count to “5”.

15. Remove and dispose of pen needle.

16. Document time, dose, site, and blood glucose value.

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Insulin Pump Therapy Based on what body does naturally

- Small amounts of insulin all the time (basal insulin)

- Extra doses to cover each meal or snack (bolus insulin)

Rapid or Short-Acting Insulin

Precision, micro-drop insulin delivery

Flexibility

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What is an Insulin Pump?

Battery operated device about the size of a pager

Reservoir filled with insulin

Computer chip with user control of insulin delivery

Worn 24 hours per day

Delivers one type of insulin

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What Pumps Do Bolus for food intake and to correct high

blood glucose levels. Many pumps will calculate bolus dosages. Delivers pre-determined amount of basal

insulin throughout the day. Some blood glucose meters communicate

with pump.

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Sampling of Pumps

Jameson:

Updated pictures.

Jameson:

Updated pictures.

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What Key Personnel Need to Know About an Insulin Pump How to deliver routine boluses for carbs and high

blood sugars. How to disconnect the pump in event the student

becomes unconscious or seizes or if instructed by diabetes care provider.

Signs/symptoms that pump site may need to be changed by student, parent, or school nurse.

When student might need an injection by pen or syringe.

Jameson:

HRA stands for Health Room Assistant. I think the purpose is pretty clear.

Jameson:

HRA stands for Health Room Assistant. I think the purpose is pretty clear.

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Insulin Pump Manufacturers

Animas Corporation

1-877-YES-PUMP (937-7867)

www.animascorp.com

Medtronic MiniMed, Inc.1-800-MINIMED (646-4633)www.minimed.com

Disetronic Medical Systems, Inc. 1-800-280-7801 www.disetronic-usa.com

Deltec Cosmo

1-800-826-9703

www.deltec.com

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Pump Supplies at School Infusion set Reservoir Insulin Skin prep items Alcohol wipes Syringe (in case of malfunction) Pump batteries Inserter (if used) Manufacturers manual, alarm card

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After Giving Insulin

Check site for leakage Correction doses:

- Retest per DMMP to check effectiveness. Meal/snack doses:

- Timeliness in relation to eating

- Supervision of food amount per DMMP