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Diabetes Care Tasks at School:What Key Personnel
Need to Know
INSULIN ADMINISTRATION
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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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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