INSULIN ADMINISTRATION

1
INSULIN ADMINISTRATION
2
Overall Goal Student Health and Learning
Following the insulin regimen is critical to
student success. But just one piece of a
comprehensive management plan.
Glucagon Administration
3

Learning Objectives

• Participants will learn
• Types of insulin
• Insulin delivery basics
• Vial and syringe administration
• Pen device administration
• Pump basics

4
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.

5
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.

6
Physiologic Insulin Therapy
Jameson I inserted this to help explain
basal/bolus therapy and the goals of insulin
replacment..
7
Jameson Not the best picture but it helps the
visual learner.
Time Activity of Human Insulins
8
Delivery Methods

• Insulin Syringe
• Insulin Pen
• Insulin Pump
• Jet Injector

9
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.

10
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.

11
Dosage Specifications

• DMMP should specify conditions clearly.
• Dosage based upon insulin to carbohydrate ratios
  for meals and snacks.
• Correction dosage to treat hyperglycemia.

12
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 BG150 (actual) minus Target BG (100) 50
  divided by Correction factor (50) 1 unit
  insulin needed
• Add together to get Insulin Bolus Dosage

13
Insulin Syringes

• Sizes 30, 50, 100 units
• Disposal-

14
Syringe Vial Preparation

• 1. Get Supplies
• Insulin (Verify)
• Syringe
• Alcohol wipe
• Disposable gloves
• Sharps container

15
Syringe Vial Preparation

• 2. Wash hands
• apply gloves
• 3. Clean the insulin vial

16
Syringe Vial Preparation

• 4. Have student select injection site.
• 5. Clean the injection site

17
Syringe Vial Preparation

• 6. Check the insulin dose
• 7. Remove the cap from syringe.

18
Syringe Vial Dosing

• 8. Pull the plunger down to number of units to be
  administered.
• 9. Inject air into bottle.

19
Syringe Vial Dosing

• 10. Draw out prescribed number of units of
  insulin as per DMMP.

20
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.

21
On Target!
Jameson I think the purpose is obvious.
22
Insulin Pen Devices

• Prefilled pens
• Reusable (cartridge) pens
• Techniques for dose preparation and insulin
  delivery are similar for both types of pen
  devices.

23
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

24
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.

25
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.
26
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

27
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

28
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.

29
Jameson Updated pictures.
Sampling of Pumps
30
What Key Personnel Need to Know About an Insulin
Pump
Jameson HRA stands for Health Room Assistant.
I think the purpose is pretty clear.

• 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.

31
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

32
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

33
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