Administering Insulin
Students with type 1 diabetes, and some students with type 2 diabetes, require insulin to be given at regular times each day. Some students may need additional or corrective dosages of insulin to treat hyperglycemia or to cover a rise in blood glucose levels. The Diabetes Medical Management Plan specifies the dosage, delivery system, and schedule for insulin administration, which will differ for each student. The nursing care plan, 504, IEP, or other education plan, which are based on the Diabetes Medical Management Plan, specify who will administer prescribed insulin and under what circumstances.
Today, new types of insulin and new delivery systems help keep blood glucose levels within the target range. These options may require closer monitoring and possibly more assistance for the student with diabetes.
Insulin has three characteristics:
- Onset is the length of time before insulin reaches the bloodstream and begins lowering blood glucose.
- Peak time is the time during which insulin is at its maximum strength in terms of lowering blood glucose.
- Duration is the number of hours insulin continues to lower blood glucose levels.
There are several types of insulin that are used in combination to treat people with diabetes. These different types of insulin have been manufactured either to have immediate (rapid-acting or short-acting insulin), intermediate, or long (basal insulin) onset of action and duration of action in the body. A coordinated combination of insulin is used to allow for adequate treatment of diabetes at meals, snacks, during periods of physical activity, and through the night. Opened vials of insulin may be left at room temperature for 30 days after opening, but will keep for 3 months if refrigerated. Unopened vials should be stored in the refrigerator and are good until the expiration date.
The three most common ways to administer insulin are with a syringe, an insulin pen, or an insulin pump:
- Insulin syringes available today make it easier to draw up the proper dosage, and shorter, smaller needles make injections easier and relatively painless.
- An insulin pen looks like a fountain pen. The pen holds a cartridge of insulin, and a needle is screwed onto its tip just before use. Insulin pens are convenient and most appropriate when children need a single type of insulin.
- An insulin pump is a computerized device that looks like a pager and is usually worn on the student’s waistband or belt. The pump is programmed to deliver small, steady doses of insulin throughout the day; additional doses are given to cover food or high blood glucose levels. The pump holds a reservoir of insulin that is attached to a system of tubing called an infusion set. Most infusion sets are started with a guide needle, then the plastic cannula (a tiny, flexible plastic tube) is left in place, taped with dressing, and the needle is removed. The cannula is usually changed every 2 or 3 days or when blood glucose levels remain above target range. More students are opting for insulin pump therapy as a means to keep blood glucose levels in better control.
Some students who need insulin during the school day are able to administer it on their own; others will need supervision; and others will need someone to administer the insulin for them. The school nurse and/or trained diabetes personnel should provide this help in accordance with the Diabetes Medical Management Plan and the nursing care plan. School personnel who are responsible for the student’s care should be knowledgeable about the use and operation of that student’s insulin delivery system. Information about insulin administration should appear in the student’s Diabetes Medical Management Plan, nursing care plan, and education plan (504, IEP, or other education plan).
In the event a school nurse is not available to administer insulin, a nurse or another qualified health care professional should teach, monitor, and supervise trained diabetes personnel to administer insulin. Further, when the school nurse is not available to administer insulin and insulin is administered by other trained diabetes personnel, additional safety precautions may be taken, such as verification of the dose by two trained diabetes personnel before administration.
Produced by the National Diabetes Education Program (NDEP), a federally sponsored partnership of the National Institutes of Health, the Centers for Disease Control and Prevention, and more than 200 public and private organizations.
To obtain copies of the complete publication titled, Helping the Student with Diabetes Succeed: A Guide for School Personnel (NDEP-61), please call the National Diabetes Education Program at 1-800-438-5383 or visit the program's website at www.ndep.nih.gov to download copies.
This reprint is compliments of Abbott Diabetes Care, Inc. Reproduced with permission.
Important Notice: Information provided is for general background purposes and is not intended as a substitute for medical diagnosis or treatment by a trained professional. You should always consult your physician about any health care questions you may have, especially before trying a new medication, diet, fitness program, or approach to health care issues.
DOC11956-Rev-A 04/08
