Intensive Diabetes Training

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Intensive Diabetes Training
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CHECKING A BLOOD SUGAR

• TO VIEW A DEMONSTRATION OF HOW TO CHECK A BLOOD
  SUGAR, YOU MAY CLICK ON THE FOLLOWING LINK AND
  SCROLL DOWN TO RUNNING A BLOOD GLUCOSE TEST
• http//www.accu-chek.com/en_US/multimedia/advan
  tage/index.html

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Carbohydrate counting

• Carbohydrate foods are those foods that are
  broken down into sugar in the body.
• Examples are bread, cereal, rice, pasta,
  crackers, corn, peas, potatoes.
• These foods will raise the blood sugar the most.
• Foods that are labeled as sugar free or no
  sugar added can have carbohydrates in them. Be
  sure to check labels on any sugar free food.

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Carbohydrate counting

• One carbohydrate choice (one serving) 15 grams
  of total carbohydrate.
• The following are some examples of foods that
  have 15 grams of carbohydrates
• ½ small bagel 15 grams carbs
• 1 slice of bread
• 2 tbsp of raisins
• 12 chips
• 1 small apple
• 1 cup lowfat milk
• Refer to the Gaston County Nutritional Analysis
  Food Guide for carbohydrate counts for cafeteria
  food.

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Insulin

• Please click on the following link to view a
  demonstration on injecting insulin. Note that
  there are different size insulin syringes.
• Insulin Injection Demonstration

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Tips on Injecting Insulin

• Most people pinch up a fold of skin and insert
  the needle at a 90 angle to the skin fold. To
  pinch your skin properly, follow these steps
• Squeeze a couple of inches of skin between your
  thumb and two fingers, pulling the skin and fat
  away from the underlying muscle. (If you use a 5
  millimeter mini-pen needle to inject, you don't
  have to pinch up the skin when injecting at a 90
  angle with this shorter needle, you don't have
  to worry about injecting into muscle.)
• Insert the needle.
• Hold the pinch so the needle doesn't go into the
  muscle.
• Push the plunger (or button if you're using a
  pen) to inject the insulin.
• Release the grip on the skin fold.
• Remove the needle from the skin.

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Tips on Injecting Insulin

• If you inject too deep, the insulin could go into
  muscle, where it's absorbed faster but might not
  last so long (and, it hurts more when you inject
  into muscle).
• If the injection isn't deep enough, the insulin
  goes into the skin, which affects the insulin's
  onset and duration of action.
• Note that not everyone injects at a 90 angle. If
  you inject into an area of the body that has less
  fat, you may need to inject at less than a 45
  angle, to avoid injecting into a muscle.

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Sites to administer insulin

• The most common injection site is the abdomen (or
  stomach). The back of the upper arms, the upper
  buttocks or hips, and the outer side of the
  thighs are also used. These sites are the best to
  inject into for two reasons
• They have a layer of fat just below the skin to
  absorb the insulin, but not many nerves - which
  means that injecting there will be more
  comfortable than injecting in other parts of your
  body. They make it easier to inject into the
  subcutaneous tissue, where insulin injection is
  recommended.
•  

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Insulin

• If you inject insulin three or more times a day
  then its a good idea to rotate your injection
  sites. Injecting in the same place much of the
  time can cause hard lumps or extra fat deposits
  to develop. These lumps are not only unsightly
  they can also change the way insulin is absorbed,
  making it more difficult to keep your blood
  glucose on target.
• Follow these two rules for proper site rotation
• Same general location at the same time each day.
• Rotate within each injection site.

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Insulin Pen

• Although there are many brands and models,
  insulin pens can be divided into two basic types
  
• Disposable pens, which come pre-filled with
  insulin. As the name implies, the pen is thrown
  away when the insulin is used up.
• Reusable pens, which are loaded with a new
  insulin cartridge when the old one is used up.
• Insulin pens aren't all the same, so it's very
  important that you carefully read and completely
  understand the operating instructions for the pen
  that you have.

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Insulin Pen Setting up the pen

• For a general idea of how pens work, here are the
  basic steps that are common to most models and
  types
• Remove the pen cap.
• Check the insulin (amount and appearance).
• Clean the injection site with an alcohol swab.
• Attach the BD pen needle and remove both caps.
• Prime the pen. (dial in 2-4 units and inject
  into the air to make sure insulin is coming out.
  This is priming the pen).
• Make sure the insulin looks ok, no chrystals or
  clumping. If the insulin is normally cloudy, be
  sure to roll the pen in your hands and turn end
  to end to mix before giving. Do not shake to
  mix.
• Dial the dose and inject.
• Remove the needle from the pen and dispose of
  properly. Put the cover back on the pen.

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Insulin Pen

• Pens from different manufacturers operate
  differently, so it's very important that you
  carefully read and completely understand the
  operating instructions for the pen that you
  choose. Some of the information you should be
  looking for when you read the instructions
• How to set your dose.
• What you should do if you accidentally dial too
  much insulin for your dose.
• How you will know if you don't have enough
  insulin remaining in the cartridge for your dose.
  
• How to load a new cartridge in your pen if it is
  a reusable pen.

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Insulin Pump

• Insulin pump therapy is the treatment that most
  closely mimics the action of a healthy pancreas.
• Insulin pumps deliver insulin 24 hours a day
  according to a programmed plan that is customized
  for you.
• A small amount of rapid-acting insulin is given
  continually (the "basal rate") to keep blood
  glucose in the desired range between meals and
  overnight. When food is eaten, you set the pump
  to deliver a "bolus dose" of rapid-acting insulin
  matched to the amount of carbohydrate that you
  will eat. What that translates to is flexibility!
  
• With pump therapy, you have more freedom to eat
  what you want, when you want, skip a meal, sleep
  in, or exercise without fear of going low.

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Insulin Pump

• The insulin pump is a small device, about the
  size and weight of a cell phone. It is not
  implanted. Insulin is delivered through a soft
  tiny tube that sits just underneath the skin and
  is changed every 2 to 3 days. A few simple button
  pushes delivers the required amount of insulin.
  The pump can easily be disconnected from the body
  for showering, swimming, or changing clothes.

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Insulin Pump Overview

• An insulin pump has several advantages over other
  forms of insulin delivery
• More precise and predictable dosing The pump
  delivers insulin in precise units as little as
  one tenth of a unit that can be closely matched
  to your needs. Furthermore, the faster acting
  insulin that pumps use has less than 3 insulin
  absorption variation. Increased precision and
  reduced variability make it easier to improve
  glucose control.
• Flexibility of meal, activity timing The pump
  gives you more freedom because of the ability to
  change the dose of rapid-acting insulin
  throughout the day according to your food intake
  and activity level.
• True basal/bolus Insulin pumps deliver
  background insulin 24 hours per day and also
  allow you to change the amount delivered at
  mealtimes. This imitates the behavior of a
  healthy pancreas.
• Improved control for fewer complications Studies
  suggest that people who use the pump are better
  able to keep their blood glucose in the target
  range.

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Insulin Pump

• Note every pump has a toll free number on the
  back of the pump to call if you have any
  questions about the pump or its functions.
  Please always call the parent or health care team
  if you have problems with blood sugars.

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MANAGEMENT OF DIABETIC EMERGENCY WITH GLUCAGON

• GLUCAGON IS ONLY GIVEN IF THE DIABETIC STUDENT IS
  UNABLE TO TAKE FOOD OR DRINK BY MOUTH OR IS
  UNCONSCIOUS
• NEVER PLACE FOOD OR DRINK IN AN UNCONSCIOUS
  STUDENTS MOUTH

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MANAGEMENT OF A DIABETIC EMERGENCY WITH GLUCAGON

• CALL 911 AND PARENT
• IF GLUCAGON IS PRESCRIBED BY THE DOCTOR AND
  PROVIDED BY THE PARENT, INJECT PRESCRIBED DOSE.

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PREPARING AND ADMINISTERING A GLUCAGON INJECTION

• CALL 911
• OPEN THE KIT AND TAKE OUT THE VIAL OF GLUCAGON
  AND THE PREFILLED SYRINGE.
• FLIP THE TOP OFF THE VIAL OF POWDERED GLUCAGON.
  TAKE THE CAP OFF THE NEEDLE. INJECT THE NEEDLE
  THROUGH THE RUBBER END ON THE VIAL AND SQUIRT ALL
  THE SOLUTION INTO THE VIAL.
• REMOVE THE NEEDLE AND SHAKE UP THE VIAL. IT MIXES
  QUICKLY.
• INSERT THE NEEDLE INTO THE VIAL, TURN THE VIAL
  WITH THE BOTTOM UP AND WITHDRAW ALL THE VIAL
  CONTENTS INTO THE SYRINGE.
• TAKE THE VIAL OFF THE NEEDLE AND, KEEPING THE
  NEEDLE POINTED UPWARD, TAP AND EXPEL ANY AIR
  BUBBLES OUT OF THE SYRINGE.
• FOLLOW PHYSICIANS DIRECTIVE FOR GLUCAGON DOSAGE.
• PINCH UP TISSUE AND INSERT THE ENTIRE NEEDLE INTO
  THE STUDENTS UPPER ARM, TOP OF THIGH, OR UPPER,
  OUTER QUADRANT OF THE BUTTOCK. FOR VERY THIN
  STUDENTS, USE A 45 DEGREE ANGLE, BUT FOR MOST,
  YOU CAN INSERT THE NEEDLE STRAIGHT IN.
• DISPOSE OF NEEDLE IN SHARPS CONTAINERDO NOT
  RECAP NEEDLE
• ROLL THE STUDENT ONTO HIS/HER SIDE, VOMITING IS
  COMMON.
• GLUCAGON SHOULD AROUSE THE STUDENT WITHIN ABOUT
  10 MINUTES.

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PREPARING AND ADMINISTERING A GLUCAGON INJECTION

• TO VIEW A DEMONSTRATION OF HOW TO PREPARE AND
  ADMINISTER A GLUCAGON INJECTION, CLICK ON THE
  FOLLOWING LINK
• http//www.novonordisk.com/images/diabetes/glucago
  n/demo/hypokit-demo.wmv

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References

• www.bddiabetes.com
• http//www.novonordisk.com/diabetes/public/hypokit
  /glucagenhypokit/default.asp