Transcript Diabetes Presentation - Iron County School District

Diabetes at School
Training For School Personnel
Insulin, Blood Checking and Glucagon
March 2009
Goals for Today
 Understand what
diabetes is
 Recognize a
hypoglycemic reaction
and know how to handle
a low blood glucose
 To be able to perform a
blood glucose check
 To learn to do
carbohydrate counting
 Overview of insulin
administration
What is Diabetes
 Diabetes is a condition in which the body cannot use
or does not produce enough insulin
 Without insulin, the body cannot get the glucose
(sugars), that are the result of food digestion, into the
cells for energy.
Insulin
 Insulin is a hormone
secreted by the
pancreas. With
diabetes it must be
given as an injection
 The dose will vary with
the blood glucose level,
food intake and
exercise
Without Insulin
Eat
No glucose in cells
Eat
Blood glucose goes up
Eat
Blood glucose goes higher
High levels of glucose (sugar) build up in the
blood.
The glucose (sugar) cannot get into the cell to
provide energy.
This is Called
Hyperglycemia
HYPERGLYCEMIA
Signs and Symptoms








Frequent urination
Increased thirst
Increased hunger
Fatigue/weakness
Weight loss
Blurry vision
Fast, deep breathing
Slow or confused
thinking
So… Hyperglycemia
 Watch Hyperglycemia Video
Insulin Should…
 Lower the blood
glucose
 Facilitate the glucose
getting into the cells to
provide energy
Insulin Can Cause Blood
Glucose to
Fall Too Low When…
 Too much insulin given
 Not enough food eaten
 Too much exercise
done
 Illness present
This is Called
Hypoglycemia
Hypoglycemia can be life threatening if not treated
because
the only energy source for the brain is blood glucose.
HYPOGLYCEMIA
Signs and Symptoms
Objective Signs (can be
observed)
• Sweating
• Poor Coordination
• Paleness
• Inappropriate
• Irritable/Moody
Actions/Responses
• Crying
• Child appears to have
• Inability to Concentrate
unusual drowsiness and
fatigue
HYPOGLYCEMIA
Signs and Symptoms
Subjective Signs (reported by
child)
 Sudden Hunger
Symptoms can progress to:
• Headache
 Confusion
• Nervousness
 Blurred Vision
• Shakiness
Late stages of
Hypoglycemia
• Confusion
include:
• Abdominal Pain
 Coma
• Unusual Drowsiness or
 Seizure
Fatigue
 Death
 Watch Hypoglycemia Video
Exercise
 When the student
exercises, the body uses
the glucose more
effectively, which can
lead to low blood glucose
(hypoglycemia)
 The effects of insulin are
more efficient with
exercise
Treatment
#1 Meal Planning




Deciding what and when to eat
Affects the whole family
Affects school and school performance
Never ending
Meal Plans
 Good nutrition is important to
everyone, however a student
with diabetes must plan their
meals carefully
 A balanced diet, with
moderation of concentrated
sweets is the best
 Counting the carbohydrates
in foods is called Carb
Counting
 Insulin is given according to
the number of carbohydrates
eaten
Carbohydrates
 Carbohydrate counting is a simple skill that is an
important component of figuring the insulin
requirement
 Carbohydrate amounts are listed on mostly
commercially packaged food items
Counting Carbohydrates
 First decide what and how much the student will be
eating
 Know the “Carb to Insulin” ratio
 ALWAYS ordered by physician such as 1:15 or 1:20
What About Candy, Fast
Foods and Sport Drinks?
#2 Checking Blood
Glucose
 Check before meals and at bedtime
 Check whenever there are symptoms of a HIGH or
LOW blood glucose are in question
Why Check Blood
Glucose?
 Checking blood glucose daily is
an important part of diabetes
control
 Helps maintain blood glucose
“target range”
 Maximize learning and
participation
 Prevention of lows and highs.
 Decrease risk of long-term
complications
Before You Start…
Know the target range:
 Young Child up to age 7 years is a blood glucose
of 100-200
 School Age (7-11 years) 80- 160
 Adolescents (12- adult) 70- 150
Consider extra checking:
 Before, during and/or after exercise
 Periods of stress or illness
 With any diabetes management changes
Things You Will Need to
Check
a Blood Glucose





Meter
Blood strips
Lancing Device
New Lancet
Sharps container
Steps for Checking
Blood Glucose





Have the student wash hands
Set up meter
Prick finger with a lancet
Apply blood to the test strip
Record results
Reading the Meter
 Turn the meter on.
 Check the code if necessary.
 The code number that appears on the meter must
match the code number on the bottle of strips.
 Insert a strip into the meter.
Blood Glucose Meters
Accu-Chek
Aviva
One Touch
UltraMini
One Touch
Ultra 2
Freestyle
Lite
Accu-Chek
Compact
Contour
Lancing the Finger
Using the outside edges of the
fingers is less painful.
Doing a Reading




Apply the blood to the strip
Wait for the results to be displayed
Disposed of the lancet and the strip
Record the results
 Watch Blood Glucose Monitoring Video
#3 Giving the Insulin
At school we will be giving
rapid-acting insulin before
meals or possibly for a blood
glucose level that is significantly
above target range.
Dose of Insulin… Bolus
Dose
Insulin dose is a calculation depending on:
 Blood glucose reading
 What food will be eaten
Calculating Food Dose
Example:
 1 unit of insulin per “X” number of carbohydrates
 The ratio is 1 unit of insulin for every 15
carbohydrates
 The student is going to have 60 carbohydrates for
lunch
 60 /15= 4 x1 unit= 4 units of insulin
Calculating for Correction
Dose
 The doctor will give a scale of how many units of
insulin are needed for every number over the target
range
 The correction dose is the amount of additional
insulin to be taken to bring the blood glucose down
to the desired target
Calculating the Bolus
Dose…
Number of units needed for food eaten
+
Correction dose for hyperglycemia if present
= Total Insulin Bolus
Insulin Delivery Systems
 Insulin Syringe
 Insulin Pen
 Insulin Pump
Insulin By Injection
Preparation of Dose with a
Syringe
 Get supplies: insulin, syringe
 Wash hands
 Clean the insulin vial
Draw Up the Insulin Dose




Remove cap from syringe
Pull the plunger down to number of units needed
Inject this air into the insulin bottle
Turn the insulin bottle upside down and draw into the
syringe the number of units of insulin needed as
calculated for the bolus dose
Giving Insulin with a
Syringe






Chose the injection site
Recheck the insulin dose
Push the needle into the skin at 90°
Push the plunger in
Count to 5-10 with the needle in
Remove the needle and dispose of the syringe in a
sharps container
 Document time, dose, and site
 Watch Insulin by Syringe and Vial Video
Insulin Pens
 Gather supplies:
 Pen device, pen needles
 Wash hands
 Clean the top of the pen device with alcohol
 Screw on pen needle
 Prime needle by dialing up 1-2 units and pushing
on the plunger until you see insulin at the end of
the needle
This may need to be repeated
 Dial in number of units of insulin needed
Insulin Delivery Systems
NovoPen Jr.
NovoLog
FlexPen
Humalog
Pens
Injection with an Insulin
Pen





Chose injection site
Push the needle in at 90°
Push down the plunger
Count to 5-10
Remove the pen needle and dispose of the pen
needle
 Document time, dose, and site
 Watch Insulin by Pen Video
Insulin Pump Therapy
 A pump is a device worn externally that delivers a
small amount of insulin continuously
 A bolus dose is given by the pump at meals or
snacks
Insulin Pumps
Animas
MiniMed
Paradigm
OmniPod
Deltec
Cozmo
Accu-Chek
Spirit
Things to Know About the
Pump




How to deliver a bolus dose
Checking injection site for leakage
What to do if the pump is alarming
How you would stop the insulin delivery by using the
“suspend” feature
 Watch Insulin by Pump Video
Insulin Reaction
This is called… HYPOGLYCEMIA.
Treatment for
Hypoglycemia
for a Conscious Person:
 If you can, check a blood glucose. If it is below 80
treat as a hypoglycemic reaction
 When in doubt or unable to check a blood glucose,
treat as a hypoglycemic reaction
Treatment for
Hypoglycemia
for a Conscious Person:
 Give a drink high in sugar:
 6oz. of regular soda pop (not diet),
 1/2-2/3 cup fruit juice
 3-4 glucose tablets
 Follow with a milk and protein - or go with them to
lunch if they can eat within 10 to 15 minutes
Hypoglycemia with
Decreased Awareness
 Glucose gels and/or tablets can be used to treat
hypoglycemia.
Examples:
Insta-glucose, Glucose 15, Glucose tablets,
Dextrose tablets.
 Gels are placed in the student’s mouth toward the
cheek and back teeth
Stay with the Child!
 You should see a response
within 15 -20 minutes
 You can repeat the treatment
in 15 minutes if symptoms are
still present or if they become
worse
Treatment for an
Unconscious Student:
 Identify someone to call 9-1-1
 Give Glucagon
 Call the parent
Glucagon
Lilly® Glucagon
Emergency Kit
Novo Nordisk®
GlucoGen® HypoKit ™
Glucagon Adverse
Reactions
 The most common side effects are nausea and
vomiting
These reactions may also occur with hypoglycemia
 Keep the student positioned on his or her side
Glucagon is Necessary:
 Children spend significant hours a day at school.
 The goal of diabetes care is to have the blood glucose
closer to normal. Despite best efforts hypoglycemia
will occur.
 Glucagon is the fastest means to raise the blood
glucose level.
Steps for
Glucagon
Administration
Preparation
1. Remove flip top seal
from vial containing dry
powder
2. Remove needle
protector from syringe
Mixing Solution
3. Slowly inject all sterile
water in syringe into the
bottle containing the
powder
4. Gently swirl vial until all
powder is dissolved
and solution is clear
(don’t shake vial)
Drawing Out & Positioning
5. Withdraw all glucagon
solution from vial
6. Turn student on his/her
side
Dosing & Injecting
7. Insert needle straight in (90 degree angle)
arm (deltoid) muscle or leg (outer thigh)
muscle
Note: Inject through clothing only if
necessary
8. Withdraw needle, apply light pressure at
injection site
Completing the Procedure
9. Place used needle back in kit and close the lid (do
not recap)
10. Give used kit to EMS personnel
Illness and Stress Affect
Diabetes
Let’s Practice!
Prepared by:
Mary Clark RN, NCSN
JMJ Publisher
Salt Lake City, Utah 84105
(801) 467-5083
for the
Utah School Nurse Association
Reviewed by:
Utah Insulin Delegation Task Force
through the Utah Diabetes
Prevention
and Control Program
Videos used with permission from:
American Diabetes Association
Utah Insulin Delegation Task Force
Jamie Ferdinand, RN, BSN, NCSN
President Utah School Nurse Association
Granite School District
Salt Lake City, UT
Email: [email protected]
Shirley Stevens, RN, BSN
President Elect Utah School Nurse
Association
Rowland Hall St. Mark's School
Salt Lake City, UT
Email: [email protected]
Cescilee Rall RN, BSN, NCSN
Past President Utah School Nurse
Association
Granite School District
Salt Lake City, UT
Email: [email protected]
Kathy Briggs, RN, BSN, NCSN
NASN Director, Utah School Nurse
Association
Granite School District
Salt Lake City, UT
Email: [email protected]
Betty Sue Hinkson, RN, Webmaster
Utah School Nurse Association
Alpine School District
American Fork, UT
Email: [email protected]
Lucie Jarrett, MS, APRN, CDE
Diabetes Clinical Nurse Specialist
Primary Children's Medical Center
Salt Lake City, UT
Email: [email protected]
Beverly Bartel
Program Manager
American Diabetes Association
Salt Lake City, UT
Email: [email protected]
Catherine A. Hamilton, RN, MS, MBA
School Nurse Consultant
UDOH/Immunization Program
Salt Lake City, UT
Email: [email protected]
Richard Bullough, Ph.D
Program Manager
Utah Diabetes Prevention & Control Program
Salt Lake City, UT
Email: [email protected]
Dawn Higley, RN, MS, CDE
Department Manager
Diabetes Management Clinic
Utah Valley Regional Medical Center
Provo, UT
Email: [email protected]
Kaylene Ellertson, RN
Public Health Education Intern
Email: [email protected]
Laura Landon
Executive Director
American Diabetes Association
Salt Lake City, UT
Email: [email protected]