2.  Objectives ◦ Show video explaining fixed carb ratio insulin therapy. ◦ Show video explaining intensive insulin therapy. ◦ Show video explaining pump therapy. ◦ Link to JDRF website with details on upcoming treatments and trials ◦ Link to podcast and blogs for evolving treatments

3.  There are two main types of manual injected insulin therapy. ◦ Fixed carb dosing ◦ Relaxed carb dosing

4. This is where the person only eats a set amount of carbs each meal. For example: They are allowed 60 carbs at each meal and their target blood glucose is 100. If there insulin to carb ratio is 1:10 and correction factor is 20, that means that they have to take 1 unit of insulin for each 10 carbs. For every 20 points over their target blood glucose they are they have to take a unit.

5.  At lunch, Hailey has a blood glucose of 260 and she is eating her 60 carbs. First you subtract 100 (target bg) from 260 (actual bg). You have 160. Then you take the 160 and divide it by 20 which equals 8. For only her bg she needs 8 units. Now, take the 60 carbs she will eat and divide it by her insulin to carb ration of 10. This gives you 6 units needed for just the food. In total she will take 14 units before she can eat.  260-100=160 160/20 =8u  60/10 = 6u  8u + 6 u = 14units of insulin before Hailey can eat.

6. This is similar to the fixed carb dosing except that the person can eat as many carbs as they want at each meal and vary the amount of times they eat a day.

7.  At lunch, Hailey has a blood glucose of 260 and she is eating 80 carbs. First you subtract 100 (target bg) from 260 (actual bg). You have 160. Then you take the 160 and divide it by 20 which equals 8. For only her bg she needs 8 units. Now, take the 80 carbs she will eat and divide it by her insulin to carb ratio of 10. This gives you 8 units needed for just the food. In total she will take 16 units before she can eat. After she eats, Hailey is still hungry so she would like to eat another 15 carbs. You will take the carbs only and does for them. In this case, 15 divided by 10 is 1.5 units. This number is rounded up to 2 units.  260-100=160 160/20 =8u  60/10 = 6u  8u + 6 u = 14units of insulin before Hailey can eat.  Then, if she wants to eat more right away…  15/10 = 1.5u = 2units of insulin before she can eat the additional carbs.

8.  The fixed dose method is predicated on the assumption that people will be eating a consistent amount of carbohydrate meal-to-meal. For people on fixed schedules, those who tend to eat the same type and quantity of food on a regular basis, this type of dosing works well. It is also appropriate for people whose understanding is limited, or who are new to insulin and want to ease into more sophisticated approaches.  However, if your food (especially carbohydrate intake) varies widely, your blood glucose may well follow, and you will end up with a pattern of erratic readings. Those that need a more flexible eating schedule do better on the relaxed carb dose method.

9. SOURCE: Healthguru. “Type 1 Diabetes Treatment”. Online video clip. YouTube. YouTube, 4 Sep. 2007. Web. 24 Aug. 2013.

10.  An insulin pump is a small mechanical device, a little larger than a pager that is worn outside the body, often on a belt or in a pocket.  It delivers fast-acting insulin into the body via an infusion set -- a thin plastic tube ending in a small, flexible plastic cannula or a very thin needle. You insert the cannula beneath the skin at the infusion site, usually in your abdomen or upper buttocks. You keep the infusion set in place for two to three days (sometimes more), and then move it to a new location. All insulin is delivered through the infusion set.

11.  The insulin pump is not an artificial pancreas. Rather, it is computer-driven device that delivers fast-acting insulin (NovoLog, Humalog, or Apidra) in precise amounts at pre-programmed times.  Wearing an insulin pump might require more work on their part than traditional injection therapy, especially if they are not used to checking their blood sugar several times a day. They must also learn to use the pump to deliver the extra insulin you require when you eat.

12. SOURCE: TriStarHealth. “Insulin Pump Therapy”. Online video clip. YouTube. YouTube, 8 Dec. 2011. Web. 24 Aug. 2013.

13.  JDRF is working on promising research for Type 1.  They believe that “to cure type 1 diabetes will require the restoration of glucose-responsive, insulin- secreting beta cells by several possible methods, such as regeneration of remaining beta cells, or transplantation of an outside source of glucose- responsive, insulin-secreting cells. Restoration of functional beta cells either by regeneration or transplantation will need to include a way to stop the immune system from attacking these cells in the future.”  See more at: http://jdrf.org/research/#sthash.2kYa7SrD.dpuf http://jdrf.org/research/#sthash.2kYa7SrD.dpuf

14. ◦ Immune Research Therapy Immune Research Therapy  Type 1 diabetes is caused by an improperly balanced immune system. JDRF is focused on developing targeted therapies, to eliminate the immune destructive cells that destroy beta cells, and/or expand the number of immune protective cells to halt the disease process.  See more at: http://jdrf.org/research/cure/#sthash.JDUBwvRN.dpuf http://jdrf.org/research/cure/#sthash.JDUBwvRN.dpuf

15. ◦ Beta Cell Regeneration Research Beta Cell Regeneration Research  JDRF-supported research has identified multiple novel ways to regrow a person’s lost beta cells. JDRF is now working to discover and develop new drugs that will cause surviving beta cells to multiply or those that reprogram other cell types to become insulin-producing beta cells.  See more at: http://jdrf.org/research/cure/#sthash.JDUBwvRN.sE7bxFhR. dpuf http://jdrf.org/research/cure/#sthash.JDUBwvRN.sE7bxFhR. dpuf

16. ◦ Beta Cell Encapsulation Research Beta Cell Encapsulation Research  JDRF’s encapsulation program is developing easily implanted products composed of beta cells surrounded by a protective shield. Such products will allow beta cells to constantly sense a person’s glucose levels and produce insulin as needed, while protecting the beta cells from further immune attack.  See more at: http://jdrf.org/research/cure/#sthash.JDUBwvRN.SjKRFOAR. dpuf http://jdrf.org/research/cure/#sthash.JDUBwvRN.SjKRFOAR. dpuf

17.  There are many podcasts and blogs to keep you up to date on Type 1 diabetes developments, research, and guidelines for care.  The Princess and the Pump The Princess and the Pump  Death of a Pancreas Blog Death of a Pancreas Blog  Our Diabetic Life Blog Our Diabetic Life Blog  Six Until Me Blog Six Until Me Blog  Typical Type 1 Blog Typical Type 1 Blog  Medical University of South Carolina Health Podcasts Medical University of South Carolina Health Podcasts  Centers for Disease Control and Prevention Podcasts Centers for Disease Control and Prevention Podcasts  Scientific American Podcasts Scientific American Podcasts

18. Proceed to end of lesson assessment.assessment