School Training - MDI Diabetes Home Care

What are we going to cover? 1.What is Diabetes? 2.Role of insulin 3.Blood glucose monitoring 4.Blood Ketone monitoring 5.The lows and the highs (hypoglycaemia and hyperglycaemia) 6.Carbohydrate counting and calculating insulin doses 7.How to administer insulin 8.Exercise management 9.Review of knowledge

What is diabetes? Difference between Type 1 and Type 2 Diabetes Type 1 characterised by high blood glucose levels caused by a defect in insulin production & therefore action Autoimmune disease-immune system destroys insulin producing beta cells which regulate BG levels Symptoms due to high BG level- polyuria/polydipsia/hunger/weight loss/blurred vision/fatigue Poor management associated with serious complications, both micro and macro vascular. Kidney, eyes, nerves….. Treatment of type 1 diabetes is life long insulin replacement either via injections or an insulin pump

The happy cell

The unhappy cell – Type 1 Diabetes

Why are we increasing the intensity of diabetes management? Acute & Chronic Complications Hypoglycaemia – Mild to severe – anxiety – Cognitive development Hyperglycaemia – Performance, Mood Diabetic Ketoacidosis – Insulin omission – Hospital admissions – Death

Blood glucose levels Normal blood sugars 4-7 mmol/L Aim for less than 10 mmol/L, 2 hours post meal Negotiated target BG level Important to monitor blood glucose levels When? Pre meals and 2 hrs after Before, during and after exercise When CYP feels symptomatic When CYP feels unwell

Practice the procedure for monitoring Blood Glucose Ensure CYP washes hands (soap & water/damp paper towel) Dry hands Uses own BG testing kit New lancet/needle each time Interpretation of results Refer to correction chart/Expert meter/bolus calculator

What is ‘Hypoglycaemia’ Blood glucose level less than 4 mmol/L “ 4 is the floor” Diabetes UK Individuals signs and symptoms should where possible be noted in the care plan

HYPO ’S

First 90 minutes peak insulin action minutes moderate insulin action After 180 minutes low insulin action

Causes of Hypoglycaemia Too much insulin Missing meals, not eating all meal Excessive exercise Extreme weather conditions Diarrhoea and Vomiting

What is ‘Hyperglycaemia’ Blood glucose level is more than 14 mmol/L Must check for Ketones: – Acidic by-product from excessive fat metabolism – Show purple ketone strips – If ketone level is 0.6mmol/l of higher contact parent or diabetes team Individuals signs and symptoms should where possible be noted in the care plan

Causes of hyperglycaemia & ketones Too little insulin More food than calculated insulin for Stress / excitement Illness / infection

Hyperglycaemia

First 90 minutes peak insulin action minutes moderate insulin action After 180 minutes low insulin action

Injection Technique

How To Dispose of Sharps Avoid handling sharps…Where possible ask the child or young person to dispose of their own needle safely

Carbohydrate Counting

Four Simple Steps See Carbohydrate Counting Booklet & easy steps 1,2,3 1.Preparation: 15 minutes before 2.Count Carbohydrate 3.Calculate & deliver insulin dose 4.Monitor intake and record

What foods contain carbohydrate?

Calculate carbohydrate for: Chicken Jambalaya 1 serving spoon rice Apple & Raisin muffin Rice Grams of CHO 1 tablespoon10 1 school serving spoon20 MENU ITEM Grams Of CHO MAIN MEALSPRIMARY Beef Hot Pot20 Bhajee and mint yogurt( 1 small)5 Cheese and potato pie15 Chicken chow mein25 Chicken curry with lentils5 Chicken jambalaya15 DESSERTS AND DRINKSCHO Angel Delight15 Apple & banana crisp20 Apple & raisin muffin20 55g total carbohydrate

Insulin Calculation- Easy Steps 1,2,3 1.Test BG 15 minutes before: – <4mmol/l - treat and wait – mmol/l – no correction needed – 7.0 – 14mmol/l – calculate correction – >14.0mmol/l – check for ketones 2.Calculate insulin for carbohydrate = Total insulin dose

Practice Blood Glucose 11.0mmo/l Carbohydrate 55g How much insulin?

Exercise

Scenarios – Use Easy 1,2,3 Lunch time: – Blood Glucose 3.5mmol/l – Carbohydrate 55g What to do? How much insulin? Lunch time: – Blood Glucose 12.0mmol/l – Carbohydrate 55g – Had a hypo at 10am What to do? How much insulin? Lunch time: – Blood Glucose 16.0mmol/l – Carbohydrate 55g What to do? How much insulin?