DIABETES CARE TASKS AT SCHOOL: What Key Personnel Need to Know INSULIN BASICS 1-800-DIABETES www.diabetes.org Goal: Optimal Student Health and Learning Accurate and timely insulin dosing is a vital piece of a comprehensive plan. 1-800-DIABETES 2

www.diabetes.org Learning Objectives Participants will be able to understand: What insulin does Types of insulin Insulin delivery methods Storing insulin

Factors that influence insulin dosing 1-800-DIABETES 3 www.diabetes.org Vocabulary Target Range: A range of numbers that represents an individuals 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)

1-800-DIABETES 4 www.diabetes.org Insulin in Schools Today Most students need to take insulin in school Insulin dosing varies from student-to-student and changes over time Students 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 5 www.diabetes.org 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 6 www.diabetes.org Insulin Delivery Methods Insulin Syringe

Insulin Pen Insulin Pump or Pod Jet Injector 1-800-DIABETES 7 www.diabetes.org Basal and Bolus Insulin Bfast

1-800-DIABETES Lunch 8 Dinner Snack www.diabetes.org Insulin Types Rapid-acting - Humalog , Novolog , Apidra Short-acting - Regular Intermediate - NPH Long-acting - Glargine (Lantus), Detemir (Levemir) 1-800-DIABETES

9 www.diabetes.org 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 10 www.diabetes.org 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 11 www.diabetes.org Where to Give Insulin: On Target! Inject into fat layer under skin Rotate sites Student should choose site 1-800-DIABETES 12 Common sites: abdomen, thigh buttocks, upper arms www.diabetes.org 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 13

www.diabetes.org Carb Bolus to Cover Meals, Snacks The insulin to carb ratio varies student to student, is specified in the DMMP: 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 1-800-DIABETES 14 www.diabetes.org Correction Bolus to Lower Blood Glucose Amount to lower blood glucose to target, usually calculated by sliding scale or correction Sliding scale: give units of insulin for each factor: 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 www.diabetes.org 1-800-DIABETES 15 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 students blood glucose is below target range, the correction may mean giving less than the usual dose 1-800-DIABETES 16 www.diabetes.org 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 1-800-DIABETES 17 www.diabetes.org

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