1. Diabetes & Insulin Pens Prepared by: Alison Deux, 4 th year pharmacy student

2. Background on Diabetes More than 9 MILLION Canadians are living with diabetes or pre-diabetes 20 more people are diagnosed every hour There are two main types of Diabetes: Type 1 Type 2

3. Type 1: Where the body is unable to produce insulin; a hormone that controls the amount of sugar in the blood. This is usually diagnosed in children and adolescents. Approximately 10% of people with diabetes have type 1.

4. Type 2: Where the body doesn’t produce enough insulin OR when the body doesn’t effectively use the insulin that is produced. This usually develops in adulthood; however, in recent years we have seen this in children as well. Approximately 90% of people with diabetes have type 2.

5. Gestational: A temporary condition that occurs during pregnancy. Pre-Diabetes: Where a person’s blood sugar levels are higher than normal, but not yet high enough to be diagnosed as type 2.

6. What is blood sugar? Blood sugar is the amount of sugar in your blood at a given time. Blood sugar testing can: Provide a quick measurement of a blood sugar level at a given time; Determine if blood sugar is high or low

7. What is blood sugar? Blood sugar is tested using a blood sugar monitor. Patients with type 1 diabetes should test their blood sugar at least twice a day To use a blood sugar monitor: – http://www.youtube.com/watch?v=rMMpeLLgdgY http://www.youtube.com/watch?v=rMMpeLLgdgY

8. What do the readings mean? Blood sugar readings should be between 4- 7mmol/L when taken before meals. If the reading is below 4, the person’s blood sugar is below target, and the person may be experiencing symptoms of low blood sugar. If the reading is above 7, the person’s blood sugar is above target, and the person may be experiencing symptoms of high blood sugar.

9. What is low blood sugar? Low blood sugar is called hypoglycemia. Signs and symptoms of hypoglycemia include sweating, hunger, shakiness, heart palpitations (heavy, fast heartbeats), anxiety, feeling irritable, mood or behaviour changes, numb lips or tongue and headache.

10. What if hypoglycemia occurs? Always carry a source of fast sugar and a snack At the first signs of low blood sugar check the blood sugar value and get the person to eat 15g of a fast acting sugar source (such as ¾ cup orange juice or regular pop; 1 glucose tablet; 6 lifesaver candies) After 10-15 minutes if the person doesn’t feel better or their blood glucose level is less than 4mmol/L, give another fast source of sugar. If their blood sugar level is still low after another 10-15 min, they should be taken to the nearest ER.

11. What if hypoglycemia occurs? If the hypoglycemia is severe (blood sugar <2.8mmol/L) 20g of CHO should be eaten. Wait 15 minutes, retest blood sugar and if below 4mmol/L take 15g CHO. If BG is >4mmol/L but their next meal or snack is 30 min or more away, immediately get them to eat a snack of 6 crackers and 1 ounce of cheese or 1 slice of bread and a tablespoonful of peanut butter or equivalent.

12. What is high blood sugar? High blood sugar is called hyperglycemia. Signs and symptoms of hyperglycemia include increased urination, increased thirst, fruity smelling breath, weakness, nausea, and/or vomiting

13. What if hyperglycemia occurs? If blood sugar is >14mmol/L and they are showing signs and symptoms of high blood sugar, contact health care providers immediately. If blood sugar is consistently higher than 7mmol/L, contact health care providers as insulin doses may need to be adjusted.

14. What is insulin? In Diabetes, the body does not produce any or enough insulin. As a result, sugar builds up in the bloodstream, potentially leading to serious health problems such as blindness, heart disease, kidney problems, etc. Insulin is a hormone that controls the amount of sugar in the blood.

15. Types of insulin There are different types of insulin available, offering flexibility in the timing and number of injections required. These include: Rapid Acting (clear) Short Acting (clear) – ex)Humulin R Intermediate Acting (cloudy) – ex)Humulin N Long Acting (clear)

16. Possible side effects of insulin Hypoglycemia Weight gain Allergic reactions

17. Insulin Keep unopened insulin in the refrigerator (temperature 2-10°C). Opened insulin can be kept at room temperature for up to 28 days (ensure to note date removed from fridge) Always check the expiry date before using. Do not allow insulin to freeze or get too hot.

18. Pens vs. Syringes Insulin Pens Easy to take with you and use on the go Easy to use Ability to give precise doses Insulin Syringes Are the “old standard” Less expensive Can use less injections if require mixed insulin doses

19. Huma-Pen https://www.mylillypen.com/luxura_howToUs e.aspx https://www.mylillypen.com/luxura_howToUs e.aspx