INSULIN ADMINISTRATION

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INSULIN 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.
Glucagon Administration
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Learning Objectives

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

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Insulin in Schools Today

• Many students need to take insulin in school
• Insulin regimens vary
• Need for assistance will vary.
• 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 room temperature as
  specified by DMMP.

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Delivery Methods

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

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When to Give Insulin

• Administer as specified by DMMP
• Generally
• Before meals
• For blood glucose levels significantly above
  target range
• For increased ketones

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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.

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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 Syringes

• Sizes 30, 50, 100 units
• Disposal-

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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 Preparation

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

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Syringe Vial Preparation

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

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Syringe Vial Preparation

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

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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 Dosing

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

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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.

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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. Remove air by pressing the plunger. Repeat
  Prime if no insulin shows.
• 8. Dial number of units to be administered as per
  DMMP.

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Insulin Pen Injecting
9. Pinch up the skin. 10. Push the needle into
the skin at 90? 11. Release pinched skin. 12.
Push down on the plunger. 13. Count to 5. 14.
Remove and dispose of pen needle.
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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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Sampling of Pumps
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Insulin Pump Manufacturers

• Disetronic Medical Systems, Inc.
  1-800-280-7801 www.disetronic-usa.com
• Deltec Cosmo
• 1-800-826-9703
• www.deltec.com

• Animas Corporation
• 1-877-YES-PUMP (937-7867)
• www.animascorp.com
• Medtronic MiniMed, Inc.1-800-MINIMED
  (646-4633)www.minimed.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

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Possible Pump Problems
Pump alarm Yes Yes No No Yes Yes

• Empty insulin reservoir ( syringe )
• Clogged infusion set
• Partially blocked infusion set
• Leaky infusion set
• Weak or dead battery
• Pump malfunction

Reference Understaning Diabetes 10th Edition, H.
Peter Chase, M.D.
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After Giving Insulin

• Check site for leakage
• Correction doses
• Retest per DMMP
• Meal/snack doses
• Timeliness
• Supervision of food amount per DMMP