1. Medications Insulin

2. Without Insulin

3. With Treatment of Insulin

4. Insulin Molecule

5. History of Insulin

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7. Insulin Syringes Sterilized before each use Needles needed to be sharpened

8. KDPCP (Kentucky Diabetes Prevention and Control Program) 2011 Insulin is like a key that opens up the door and allows the sugar to get out of the blood and inside the cell where the cell can burn the fuel for energy! Why is Insulin So Important?…

9. KDPCP (Kentucky Diabetes Prevention and Control Program) 2011 If the sugar stayed in your blood – it doesnt do your cells (body) any good. The sugar has to get inside the cells for the body to use it. Why is Insulin So Important?…

10. Insulin in Schools Today Most student need to take insulin in school Insulin dosing varies from student to student and change over time Student's needs for assistance will vary as the student progresses in self- management Insulin dosing and timing will be specified by the treating physician – May include provisions for the parent/student who are capable to modify dosing

11. Vocabulary Target Range: – A range of numbers that represents and individuals ideal blood glucose level – Determined by health care team with the individual child and their family

12. Vocabulary Basal Insulin: – Sometimes called background insulin – The insulin that is working steadily throughout the day

13. Vocabulary Bolus Insulin – A single does of insulin, given for one of two reasons Carb/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

14. Insulin's Classified by action - onset, peak and duration: Rapid (bolus/meal) Short action Intermediate Long acting (basal) There are also mixtures

15. Insulin Action Times Type of Insulin Generic/Trade Name Time of Onset Peak Action When the insulin has the strongest effect Hours of Duration How long the insulin usually lasts Rapid-Acting lispro (Humalog®) aspart (Novolog®) glulisine (Apidra®) 5-15 minutes30-90 minutes< 5 hours Short-Acting Regular (Humulin R ®, Novolin R®) 30-62 minutes2-3 hours5-8 hours Intermediate- Acting NPH (Humulin N ®, Novolin N ®) 2-4 hours4-10 hours10-16 hours Long Acting (Basel Insulin) Glargine (Lantus ®) Detemir (Levemire®) 2-4 hours 3-8 hours No PeakUp to 24 hours

16. 1-800-DIABETES www.diabetes.org 16 Insulin Types Rapid-acting - Humalog ®, Novolog ®, Apidra Short-acting - Regular Intermediate - NPH Long-acting - Glargine (Lantus), Detemir (Levemir)

17. 1-800-DIABETES www.diabetes.org 17 Bfast Lunch Dinner Snack Basal and Bolus Insulin

18. 1-800-DIABETES www.diabetes.org 18 Where to Give Insulin: On Target! Inject into fat layer under skin Rotate sites Student should choose site Common sites: abdomen, thigh buttocks, upper arms

19. Insulin Delivery Methods Insulin Syringe Insulin Pen Insulin Pump or Pod Jet Injector

20. Insulin Syringes U-30 U-50 U-100 One time one person use only!

21. Insulin Pens CDC just sent an Alert: PENS are one person specific in use

22. Types of Pens

23. Insulin Pumps/Pods

24. 1-800-DIABETESwww.diabetes.org 24 Insulin Pens Techniques for dosing and insulin delivery are similar for both types of pen devices: Prefilled pens Reusable (cartridge) pens Both long-acting or basal insulin and rapid-acting or bolus insulin are available in pens Most students will only take rapid-acting or bolus insulin in school

25. 1-800-DIABETES www.diabetes.org Insulin Pen: Preparation 1. Gather supplies. Verify insulin type pen device (with cartridge) pen needle 2. Have student chose injection site 3. Clean injection site 4. Screw on pen needle

26. 1-800-DIABETES www.diabetes.org Insulin Pen: Dosing 5. Prime: Dial 2 units. If the pen is being used for the first time, prime 4-6 units as per manufacturers instruction 6. Hold upright. Remove air by pressing the plunger. Repeat Prime if no insulin shows at end of needle 7. Dial number of units to be administered as per Health Care Plan

27. 1-800-DIABETES www.diabetes.org Insulin Pen: Injecting 8. Administer the injection 9. Push down on the plunger 10. Count to 5 11. Remove and dispose of pen needle 12. Complete the needed documentation

28. Oral Medications Metformin Approved for use in children 10- 16 years of age with type 2 Two common side effects Diarrhea Nausea Low risk of causing hypoglycemia

29. Polycystic Ovary Syndrome (PCOS) Ovulation Abnormality Metformin can normalize the abnormality thus higher risk for unplanned pregnancy

30. Vital Components Student and parent education Family support

31. Presentation Resources ADA Diabetes Care in the School and Day Care Setting, Diabetes Care, January 2012 The Art and Science of Diabetes Self- Management Education Desk Reference, 2011 KY Diabetes Prevention and Control Program, Diabetes Basics Presentation, 2011 KY Diabetes Prevention and Control Staff National Association of School Nurses KDPCP (Kentucky Diabetes Prevention and Control Program) 2011