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    Diabetes Care Tasks at School:What Key Personnel

    Need to Know

    INSULIN ADMINISTRATION

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    2

    Overall Goal: Student

    Health and Learning

    Following the

    insulin regimen iscritical to student

    success.

    But just one piece of

    a comprehensive

    management plan.Exercise

    LegalRights

    Health

    &Learning

    NutritionInsulinAdministration

    Hypoglycemia&Hyperglycemia

    Ketones

    MonitoringBlood

    Glucose

    GlucagonAdministration

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    3

    Part ic ipants w il l learn:

    4 Types of insulin

    4 Insulin delivery basics4 Vial and syringe administration

    4 Pen device administration

    4 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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    BasalInsul in

    Prand ial Boluses

    0hr 24hr

    BGm

    g/dl

    Physiologic Insulin Therapy

    Jameson:

    I inserted this to

    help explain

    basal/bolus

    therapy and the

    goals of insulinreplacment..

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    Time Activity ofHuman Insulins

    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 Insulin

    Administer 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 readings Food availability/preference

    Physical activity level

    Age/body weight

    Follow prescribed guideline in DMMP.

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    Dosage Specifications

    DMMP shou ld speci fy cond i t ion s clear ly.

    Dosage based upon insulin to carbohydrateratios 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 10gms 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 onDMMP

    - Correction factor: Blood glucose leveltarget blood glucose/correctionfactor = units insulin to be given

    - Ex: BG=150 (actual) minus Target BG (100) = 50 divided by Correctionfactor (50) = 1 unit insulin needed

    Add together to get Insulin Bolus Dosage

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    Insulin Syringes

    Sizes30, 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: Preparation

    2. 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 tonumber of units to beadministered.

    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: Injecting

    11. 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 ofsyringe.

    17. Document time, dosage, site, andblood glucose value.

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    Insulin Pen: Devices

    Prefilled pens

    Reusable (cartridge) pensTechniques 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 theplunger. 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: Injecting

    9. 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 communicatewith pump.

    Jameson:

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    Sampling of Pumps

    Jameson:

    Updated pictures.

    Jameson:

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    WhatKey PersonnelNeed 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 bydiabetes care provider.

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

    When student might need an injection by pen orsyringe.

    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