diabetes care tasks at school: what key personnel need to know diabetes care tasks at school: what...
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Diabetes Care Tasks at Diabetes Care Tasks at School:School:
What Key Personnel What Key Personnel Need to KnowNeed to Know
Diabetes Care Tasks at Diabetes Care Tasks at School:School:
What Key Personnel What Key Personnel Need to KnowNeed to Know
INSULIN ADMINISTRATIONINSULIN ADMINISTRATION
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Overall Goal: Student Health and Learning
Following the insulin regimen is critical to student success.But just one piece of a comprehensive management plan.
Exercise
LegalRights
Health&
Learning
Nutrition
InsulinAdministratio
n
Hypoglycemia &
Hyperglycemia
Ketones
Monitoring
Blood Glucose
Glucagon Administrati
on
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Participants will learn: Types of insulin Insulin delivery basics Vial and syringe administration Pen device administration 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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Basal Insulin
Prandial BolusesIn
suli
n
0hr 24hr
BG
mg
/dl
Physiologic Insulin Therapy
Jameson:
I inserted this to help explain basal/bolus therapy and the goals of insulin replacment..
Jameson:
I inserted this to help explain basal/bolus therapy and the goals of insulin replacment..
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Time Activity of Human Insulins
Jameson:
Not the best picture but it helps the visual learner.
Jameson:
Not the best picture but it helps the visual learner.
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When to Give InsulinAdminister 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 readingsFood availability/preferencePhysical activity levelAge/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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Syringe & Vial: Preparation
1. Get Supplies Insulin (Verify) Syringe Alcohol wipe Disposable gloves Sharps container
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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: Injecting11. 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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Insulin Pen: Devices
Prefilled pens
Reusable (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: Injecting9. 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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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.
Jameson:
HRA stands for Health Room Assistant. I think the purpose is pretty clear.
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