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1-800-DIABETES www.diabetes.org
DIABETES CARE TASKS AT SCHOOL:
What Key Personnel Need to Know
INSULIN BASICS
1-800-DIABETES www.diabetes.org
2
Goal: Optimal Student Health
and Learning
Accurate and timely
insulin dosing is a vital
piece of a
comprehensive plan.
1-800-DIABETES www.diabetes.org
3
Participants will be able to understand:
• What insulin does
• Types of insulin
• Insulin delivery methods
• Storing insulin
• Factors that influence insulin dosing
Learning Objectives
1-800-DIABETES www.diabetes.org
Vocabulary
Target Range: A range of numbers that represents an individual’s
ideal blood glucose level; determined by health care team with the
individual (child with diabetes and parent/guardian)
Basal Insulin: Sometimes called "background" insulin, the insulin
working steadily throughout the day
Bolus Insulin: a single dose of insulin, given for one of two reasons:
• Carb or Meal/Snack Bolus: Insulin dosed when food is eaten
• Correction Bolus: Insulin dosed when blood glucose level is too
high and needs to be corrected (made lower)
4
1-800-DIABETES www.diabetes.org
5
Insulin in Schools Today
• Most students need to take insulin in school
• Insulin dosing varies from student-to-student and changes
over time
• Student’s need for assistance will vary as the student
progresses in self-management
• Insulin dosing and timing will be specified in the DMMP;
physician orders may include provisions for the parent/
guardian and/or capable students to modify dosing
• Specific school procedures for administration should be
documented
1-800-DIABETES www.diabetes.org
6
What is Insulin?
Insulin is a hormone that is necessary:
• Moves glucose from blood into cells for energy
Students with type 1 diabetes do not produce insulin
Without enough insulin, high blood glucose results:
• Energy levels are low
• Dehydration
• Complications
1-800-DIABETES www.diabetes.org
7
Insulin Delivery Methods
• Insulin Syringe
• Insulin Pen
• Insulin Pump or Pod
• Jet Injector
1-800-DIABETES www.diabetes.org
8
B’fast Lunch Dinner Snack
Basal and Bolus Insulin
1-800-DIABETES www.diabetes.org
9
Insulin Types
• Rapid-acting - Humalog ®, Novolog ®, Apidra
• Short-acting - Regular
• Intermediate - NPH
• Long-acting - Glargine (Lantus), Detemir (Levemir)
1-800-DIABETES www.diabetes.org
10
Storing Insulin
• Review the product storage instructions and check
the expiration date
• Generally store at room temperature less than 86
degrees
• Refrigerate unopened vials and insulin pens
• Be careful NOT to freeze
1-800-DIABETES www.diabetes.org
11
When to Give Insulin
DMMP should specify dosing clearly
Generally:
• Before meals or snacks
• For blood glucose levels significantly above target range
• For moderate or large ketones
1-800-DIABETES www.diabetes.org
12
Where to Give Insulin: On Target!
• Inject into fat layer under skin
• Rotate sites
• Student should choose site • Common sites: abdomen,
thigh buttocks, upper arms
1-800-DIABETES www.diabetes.org
13
Dosing Insulin at School
Generally, students will only take rapid or
short acting insulin at meal or snack times:
• Some students will use a standing insulin dose
• Others will have a varied dose, depending upon:
− what food is eaten (carb bolus)
and/or
− whether blood glucose is within the target range
(correction bolus)
1-800-DIABETES www.diabetes.org
14
Carb Bolus to Cover Meals, Snacks
• Recorded as 1 unit insulin per X gms of carb
• Example: 1:10 ratio; 1 unit of insulin for every
10 grams of carb eaten
• Calculate: Meal of 60 grams CHO
– 60/10 = 6
– 6 unite of insulin are needed to cover this meal
The insulin to carb ratio varies student
to student, is specified in the DMMP:
1-800-DIABETES www.diabetes.org
15
Correction Bolus to Lower Blood
Glucose
• Sliding scale: give units of insulin for each interval of BG
– Example: 1 unit 150-200, 2 units 201-250, 3 units 250+
• Correction factor: Blood glucose level – target blood
glucose/correction factor = units insulin to be given
– Example: BG=150 (actual) minus Target BG (100) = 50 divided
by Correction factor (50) = 1 unit insulin needed
Amount to lower blood glucose to target, usually
calculated by sliding scale or correction factor:
1-800-DIABETES www.diabetes.org
16
Insulin Bolus for Both Carbs and
Correction
• For some students, dosing at meal time may
include both a carbohydrate ratio dose and a
correction dose
• Total dose = Carb ratio dose + Correction dose
• If student’s blood glucose is below target range,
the correction may mean giving less than the
usual dose
1-800-DIABETES www.diabetes.org
17
After Giving Insulin
• Check site for leakage
• Document on log sheet
• 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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5-insulin.ppt

  • 1. 1-800-DIABETES www.diabetes.org DIABETES CARE TASKS AT SCHOOL: What Key Personnel Need to Know INSULIN BASICS
  • 2. 1-800-DIABETES www.diabetes.org 2 Goal: Optimal Student Health and Learning Accurate and timely insulin dosing is a vital piece of a comprehensive plan.
  • 3. 1-800-DIABETES www.diabetes.org 3 Participants will be able to understand: • What insulin does • Types of insulin • Insulin delivery methods • Storing insulin • Factors that influence insulin dosing Learning Objectives
  • 4. 1-800-DIABETES www.diabetes.org Vocabulary Target Range: A range of numbers that represents an individual’s ideal blood glucose level; determined by health care team with the individual (child with diabetes and parent/guardian) Basal Insulin: Sometimes called "background" insulin, the insulin working steadily throughout the day Bolus Insulin: a single dose of insulin, given for one of two reasons: • Carb or Meal/Snack Bolus: Insulin dosed when food is eaten • Correction Bolus: Insulin dosed when blood glucose level is too high and needs to be corrected (made lower) 4
  • 5. 1-800-DIABETES www.diabetes.org 5 Insulin in Schools Today • Most students need to take insulin in school • Insulin dosing varies from student-to-student and changes over time • Student’s need for assistance will vary as the student progresses in self-management • Insulin dosing and timing will be specified in the DMMP; physician orders may include provisions for the parent/ guardian and/or capable students to modify dosing • Specific school procedures for administration should be documented
  • 6. 1-800-DIABETES www.diabetes.org 6 What is Insulin? Insulin is a hormone that is necessary: • Moves glucose from blood into cells for energy Students with type 1 diabetes do not produce insulin Without enough insulin, high blood glucose results: • Energy levels are low • Dehydration • Complications
  • 7. 1-800-DIABETES www.diabetes.org 7 Insulin Delivery Methods • Insulin Syringe • Insulin Pen • Insulin Pump or Pod • Jet Injector
  • 8. 1-800-DIABETES www.diabetes.org 8 B’fast Lunch Dinner Snack Basal and Bolus Insulin
  • 9. 1-800-DIABETES www.diabetes.org 9 Insulin Types • Rapid-acting - Humalog ®, Novolog ®, Apidra • Short-acting - Regular • Intermediate - NPH • Long-acting - Glargine (Lantus), Detemir (Levemir)
  • 10. 1-800-DIABETES www.diabetes.org 10 Storing Insulin • Review the product storage instructions and check the expiration date • Generally store at room temperature less than 86 degrees • Refrigerate unopened vials and insulin pens • Be careful NOT to freeze
  • 11. 1-800-DIABETES www.diabetes.org 11 When to Give Insulin DMMP should specify dosing clearly Generally: • Before meals or snacks • For blood glucose levels significantly above target range • For moderate or large ketones
  • 12. 1-800-DIABETES www.diabetes.org 12 Where to Give Insulin: On Target! • Inject into fat layer under skin • Rotate sites • Student should choose site • Common sites: abdomen, thigh buttocks, upper arms
  • 13. 1-800-DIABETES www.diabetes.org 13 Dosing Insulin at School Generally, students will only take rapid or short acting insulin at meal or snack times: • Some students will use a standing insulin dose • Others will have a varied dose, depending upon: − what food is eaten (carb bolus) and/or − whether blood glucose is within the target range (correction bolus)
  • 14. 1-800-DIABETES www.diabetes.org 14 Carb Bolus to Cover Meals, Snacks • Recorded as 1 unit insulin per X gms of carb • Example: 1:10 ratio; 1 unit of insulin for every 10 grams of carb eaten • Calculate: Meal of 60 grams CHO – 60/10 = 6 – 6 unite of insulin are needed to cover this meal The insulin to carb ratio varies student to student, is specified in the DMMP:
  • 15. 1-800-DIABETES www.diabetes.org 15 Correction Bolus to Lower Blood Glucose • Sliding scale: give units of insulin for each interval of BG – Example: 1 unit 150-200, 2 units 201-250, 3 units 250+ • Correction factor: Blood glucose level – target blood glucose/correction factor = units insulin to be given – Example: BG=150 (actual) minus Target BG (100) = 50 divided by Correction factor (50) = 1 unit insulin needed Amount to lower blood glucose to target, usually calculated by sliding scale or correction factor:
  • 16. 1-800-DIABETES www.diabetes.org 16 Insulin Bolus for Both Carbs and Correction • For some students, dosing at meal time may include both a carbohydrate ratio dose and a correction dose • Total dose = Carb ratio dose + Correction dose • If student’s blood glucose is below target range, the correction may mean giving less than the usual dose
  • 17. 1-800-DIABETES www.diabetes.org 17 After Giving Insulin • Check site for leakage • Document on log sheet • Correction doses: - Retest per DMMP to check effectiveness • Meal/snack doses: - Timeliness in relation to eating - Supervision of food amount per DMMP