Diabetes at School March 2009 Training For School Personnel Insulin, Blood Checking and Glucagon.
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Transcript of Diabetes at School March 2009 Training For School Personnel Insulin, Blood Checking and Glucagon.
Diabetes at Diabetes at SchoolSchool
March 2009
Training For School PersonnelInsulin, Blood Checking and
Glucagon
Goals for Today Understand what diabetes
is Recognize a hypoglycemic
reaction and know how to handle a low blood glucose
To be able to perform a blood glucose check
To learn to do carbohydrate counting
Overview of insulin administration
What is Diabetes
Diabetes is a condition in which the body cannot use or does not produce enough insulin
Without insulin, the body cannot get the glucose (sugars), that are the result of food digestion, into the cells for energy.
Insulin
Insulin is a hormone secreted by the pancreas. With diabetes it must be given as an injection
The dose will vary with the blood glucose level, food intake and exercise
Without Insulin
High levels of glucose (sugar) build up in the blood.
The glucose (sugar) cannot get into the cell to provide energy.
Eat
Eat Blood glucose goes up
Eat Blood glucose goes higher
No glucose in cells
HYPERGLYCEMIASigns and Symptoms
Frequent urination Increased thirst Increased hunger Fatigue/weakness Weight loss Blurry vision Fast, deep breathing Slow or confused
thinking
Insulin Should…
Lower the blood glucose
Facilitate the glucose getting into the cells to provide energy
Insulin Can Cause Blood Glucose to
Fall Too Low When…
Too much insulin given
Not enough food eaten
Too much exercise done
Illness present
This is Called Hypoglycemia
Hypoglycemia can be life threatening if not treated because
the only energy source for the brain is blood glucose.
HYPOGLYCEMIASigns and Symptoms
• Sweating
• Paleness
• Irritable/Moody
• Crying • Inability to Concentrate
• Poor Coordination • Inappropriate Actions/Responses • Child appears to have unusual drowsiness and fatigue
Objective Signs (can be observed)
HYPOGLYCEMIASigns and Symptoms
Subjective Signs (reported by child) Sudden Hunger • Headache • Nervousness • Shakiness • Confusion • Abdominal Pain • Unusual Drowsiness or Fatigue
Symptoms can progress to: Confusion Blurred Vision
Late stages of Hypoglycemia
include: Coma Seizure Death
Exercise
When the student exercises, the body uses the glucose more effectively, which can lead to low blood glucose (hypoglycemia)
The effects of insulin are more efficient with exercise
#1 Meal Planning
Deciding what and when to eat Affects the whole family Affects school and school performance Never ending
Meal Plans Good nutrition is important
to everyone, however a student with diabetes must plan their meals carefully
A balanced diet, with moderation of concentrated sweets is the best
Counting the carbohydrates in foods is called Carb Counting
Insulin is given according to the number of carbohydrates eaten
Carbohydrates
Carbohydrate counting is a simple skill that is an important component of figuring the insulin requirement
Carbohydrate amounts are listed on mostly commercially packaged food items
Counting Carbohydrates
First decide what and how much the student will be eating
Know the “Carb to Insulin” ratio ALWAYS ordered by physician such as 1:15 or
1:20
#2 Checking Blood Glucose
Check before meals and at bedtime Check whenever there are symptoms of a
HIGH or LOW blood glucose are in question
Why Check Blood Glucose?
Checking blood glucose daily is an important part of diabetes control
Helps maintain blood glucose “target range”
Maximize learning and participation
Prevention of lows and highs. Decrease risk of long-term
complications
Before You Start…
Know the target range: Young Child up to age 7 years is a blood
glucose of 100-200 School Age (7-11 years) 80- 160 Adolescents (12- adult) 70- 150
Consider extra checking: Before, during and/or after exercise Periods of stress or illness With any diabetes management changes
Things You Will Need to Check
a Blood Glucose
Meter Blood strips Lancing Device New Lancet Sharps container
Steps for Checking Blood Glucose
Have the student wash hands Set up meter Prick finger with a lancet Apply blood to the test strip Record results
Reading the Meter
Turn the meter on. Check the code if necessary.
The code number that appears on the meter must match the code number on the bottle of strips.
Insert a strip into the meter.
Blood Glucose Meters
One Touch Ultra 2
One Touch UltraMiniAccu-Chek
Aviva
Freestyle Lite
Accu-Chek Compact
Contour
Doing a Reading
Apply the blood to the strip Wait for the results to be displayed Disposed of the lancet and the strip Record the results
#3 Giving the Insulin
At school we will be givingrapid-acting insulin beforemeals or possibly for a bloodglucose level that is
significantlyabove target range.
Dose of Insulin… Bolus Dose
Insulin dose is a calculation depending on: Blood glucose reading What food will be eaten
Calculating Food Dose
Example: 1 unit of insulin per “X” number of
carbohydrates The ratio is 1 unit of insulin for every 15
carbohydrates The student is going to have 60 carbohydrates
for lunch 60 /15= 4 x1 unit= 4 units of insulin
Calculating for Correction Dose
The doctor will give a scale of how many units of insulin are needed for every number over the target range
The correction dose is the amount of additional insulin to be taken to bring the blood glucose down to the desired target
Calculating the Bolus Dose…
Number of units needed for food eaten+
Correction dose for hyperglycemia if present
= Total Insulin Bolus
Draw Up the Insulin Dose
Remove cap from syringe Pull the plunger down to number of units
needed Inject this air into the insulin bottle Turn the insulin bottle upside down and draw
into the syringe the number of units of insulin needed as calculated for the bolus dose
Giving Insulin with a Syringe
Chose the injection site Recheck the insulin dose Push the needle into the skin at 90° Push the plunger in Count to 5-10 with the needle in Remove the needle and dispose of the syringe
in a sharps container Document time, dose, and site
Insulin Pens
Gather supplies:Pen device, pen needles
Wash hands Clean the top of the pen device with alcohol Screw on pen needle
Prime needle by dialing up 1-2 units and pushing on the plunger until you see insulin at the end of the needleThis may need to be repeated
Dial in number of units of insulin needed
Injection with an Insulin Pen
Chose injection site Push the needle in at 90° Push down the plunger Count to 5-10 Remove the pen needle and dispose of the
pen needle Document time, dose, and site
Insulin Pump Therapy
A pump is a device worn externally that delivers a small amount of insulin continuously
A bolus dose is given by the pump at meals or snacks
Things to Know About the Pump
How to deliver a bolus dose Checking injection site for leakage What to do if the pump is alarming How you would stop the insulin delivery by
using the “suspend” feature
Treatment for Hypoglycemia
for a Conscious Person: If you can, check a blood glucose. If it is below
80 treat as a hypoglycemic reaction When in doubt or unable to check a blood
glucose, treat as a hypoglycemic reaction
Treatment for Hypoglycemia
for a Conscious Person: Give a drink high in sugar:
6oz. of regular soda pop (not diet),1/2-2/3 cup fruit juice3-4 glucose tablets
Follow with a milk and protein - or go with them to lunch if they can eat within 10 to 15 minutes
Hypoglycemia with Decreased Awareness
Glucose gels and/or tablets can be used to treat hypoglycemia.
Examples: Insta-glucose, Glucose 15, Glucose
tablets, Dextrose tablets.
Gels are placed in the student’s mouth toward the cheek and back teeth
Stay with the Child!
You should see a response within 15 -20 minutes
You can repeat the treatment in 15 minutes if symptoms are still present or if they become worse
Glucagon Adverse Reactions
The most common side effects are nausea and vomitingThese reactions may also occur with hypoglycemia
Keep the student positioned on his or
her side
Glucagon is Necessary:
Children spend significant hours a day at school.
The goal of diabetes care is to have the blood glucose closer to normal. Despite best efforts hypoglycemia will occur.
Glucagon is the fastest means to raise the blood glucose level.
Preparation1. Remove flip top seal
from vial containing dry powder
2. Remove needle protector from syringe
Mixing Solution3. Slowly inject all sterile
water in syringe into the bottle containing the powder
4. Gently swirl vial until all powder is dissolved and solution is clear (don’t shake vial)
Drawing Out & Positioning
5. Withdraw all glucagon solution from vial
6. Turn student on his/her side
Dosing & Injecting7. Insert needle straight in (90 degree
angle) arm (deltoid) muscle or leg (outer thigh) muscleNote: Inject through clothing only if necessary
8. Withdraw needle, apply light pressure at injection site
Completing the Procedure
9. Place used needle back in kit and close the lid (do not recap)
10.Give used kit to EMS personnel
Let’s Practice!Prepared by: Mary Clark RN, NCSN
JMJ PublisherSalt Lake City, Utah 84105
(801) 467-5083for the
Utah School Nurse Association
Reviewed by:Utah Insulin Delegation Task
Forcethrough the Utah Diabetes
Preventionand Control Program
Videos used with permission from:American Diabetes Association
Utah Insulin Delegation Task ForceJamie Ferdinand, RN, BSN, NCSNPresident Utah School Nurse AssociationGranite School DistrictSalt Lake City, UT Email: [email protected]
Shirley Stevens, RN, BSNPresident Elect Utah School Nurse
AssociationRowland Hall St. Mark's SchoolSalt Lake City, UT Email: [email protected]
Cescilee Rall RN, BSN, NCSNPast President Utah School Nurse
AssociationGranite School DistrictSalt Lake City, UT Email: [email protected]
Kathy Briggs, RN, BSN, NCSNNASN Director, Utah School Nurse
AssociationGranite School DistrictSalt Lake City, UT Email: [email protected]
Betty Sue Hinkson, RN, WebmasterUtah School Nurse AssociationAlpine School DistrictAmerican Fork, UT Email: [email protected]
Beverly BartelProgram ManagerAmerican Diabetes AssociationSalt Lake City, UT Email: [email protected]
Richard Bullough, Ph.DProgram ManagerUtah Diabetes Prevention & Control
ProgramSalt Lake City, UT Email: [email protected]
Kaylene Ellertson, RNPublic Health Education InternEmail: [email protected]
Lucie Jarrett, MS, APRN, CDEDiabetes Clinical Nurse SpecialistPrimary Children's Medical CenterSalt Lake City, UT Email: [email protected]
Catherine A. Hamilton, RN, MS, MBASchool Nurse ConsultantUDOH/Immunization ProgramSalt Lake City, UT Email: [email protected]
Dawn Higley, RN, MS, CDEDepartment Manager Diabetes Management ClinicUtah Valley Regional Medical CenterProvo, UTEmail: [email protected]
Laura LandonExecutive DirectorAmerican Diabetes AssociationSalt Lake City, UT Email: [email protected]