Transcript Document

Diabetes Care Tasks at School:
What Key Personnel
Need to Know
INSULIN ADMINISTRATION
Overall Goal: Student
Health and Learning
Monitoring
Blood
Glucose
Hypoglycemia &
Hyperglycemia
Ketones
Glucagon Health
Administration &
Insulin
Legal
Rights
Learning
Administration
Nutrition
Exercise
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Following the
insulin regimen is
critical to student
success.
But just one piece of
a comprehensive
management plan.
Learning Objectives
Participants will learn:
Types of insulin
 Insulin delivery basics
 Vial and syringe administration
 Pen device administration
 Pump basics

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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



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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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Jameson:
I inserted this to
help explain
basal/bolus
therapy and the
goals of insulin
replacment..
Physiologic Insulin Therapy
Prandial Boluses
BG mg/dl
Basal Insulin
0hr
24hr
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Jameson:
Not the best
picture but it
helps the visual
learner.
Time Activity of
Human Insulins
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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 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: 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 to
number of units to be
administered.
9. Inject air into bottle.
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Syringe & Vial: Dosing
10. Draw out prescribed
number of units of insulin
as per DMMP.
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Check Dose
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 of
syringe.
17. Document time, dosage, site, and
blood glucose value.
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Jameson:
I think the
purpose is
obvious.
On Target!
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Insulin Pen: Devices
Prefilled
Reusable
pens
(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: 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 communicate
with pump.
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Jameson:
Updated pictures.
Sampling of Pumps
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Jameson:
HRA stands for
Health Room
Assistant. I think
the purpose is
pretty clear.
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.
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Insulin Pump Manufacturers

Animas Corporation
1-877-YES-PUMP (937-7867)
www.animascorp.com

Disetronic Medical Systems, Inc.
1-800-280-7801
www.disetronic-usa.com

Medtronic MiniMed, Inc.
1-800-MINIMED (646-4633)
www.minimed.com

Deltec Cosmo
1-800-826-9703
www.deltec.com
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Pump Supplies at School

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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
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