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Skills Insulin

Diabetes Self-Care: What Does My Child Need to Know???Injecting self with insulin for type 1 diabetes

Part 4: Insulin

For background information for this article, see:
Part 1: Introduction to Diabetes Self-Care Task Analysis
Part 2: Overview of Skills


Task Analysis for Some Common Diabetes Self-Care Tasks:


This breakdown is an outline of skills (related to delivering and adjusting insulin) to consider when handing diabetes care over to your child. It is only a suggested starting point;  we recommend you consult your child’s diabetes health care team and adapt them for your family’s own individual situation, adding, deleting and/or further breaking down the steps as needed, to create a diabetes self-care task analysis that is individualized for you and your child or teen.


Tasks and Steps:

1. The Physical Process:

Delivering Insulin via Syringe:

a. If using Humulin N or NPH, mixes the cartridge or vial properly.
(For more information, see Level1/Basics/Preparing Insulin)

b. Accurately draws up correct amount of insulin ensuring that there are no bubbles.

c. Chooses an injection site (good absorption, not overused).

d. Injects the insulin.
(For more information, see Level1/Basics/Injecting Insulin)

e. Disposes of the syringe safely.

f. Effectively rotates sites.
(For more information, see Level1/Basics/Injecting Insulin, Choosing an Injection Site)

g. Recognizes the signs and symptoms of a possible site infection, and alerts caregiver.

OR

Delivering Insulin via Insulin Pen:

a. If using Humulin N or NPH, mixes the cartridge or vial properly.
(For more information, see Level1/Basics/Preparing Insulin)

b. Applies needle tip to injection site.

c. Holds pen upright and shoots 2 units into the air.

d. Dials correct insulin dose.

e. Chooses an injection site (good absorption, not overused).

f. Injects the insulin.
(For more information, see Level1/Basics/Injecting Insulin)

g. Holds pen in place for 10 seconds.

h. Removes needle tip.

i. Disposes of needle tip safely.

OR

Delivering Insulin via Insulin Pump:

a. Navigates menus to arrive at screen showing suggested dosage.

b. Correctly identifies the suggested dose.

c. Dials in the correct dose:

i. To match the suggested dose, OR

ii. Adjusts up or down according to personal experience
(based on amount of insulin still active, exercise planned or completed, glycemic index of food just eaten, etc).

d. Actually delivers insulin dose by confirming the selection.

e. Ensures insulin was actually delivered by checking the end screen for the absence of error messages.

f. If error message:

i. Checks pump history to determine how much, if any, insulin was delivered.

ii. Determines how much, if any, insulin needs to be re-delivered (if less than the total intended dose was delivered).


2.  Determining correct timing of insulin (when to deliver for optimal control):

a. Boluses before eating.

b. Adjusts timing based on blood glucose.
(For more information on timing of insulin, see: Level1/Blood Glucose Management/Taming Post-Meal Spikes-coming soon)

c. Adjusts timing based on Glycemic Index.
For more information on Glycemic Index and its Effect on Blood Glucose, see:
 
Level1/BG Management/Taming Post-Meal Spikes-coming soon
Level1/Nutrition/Intro to Glycemic Index
Level2/Nutrition/Glycemic Index Explained
Level3/Nutrition/Adjusting for GI Level


3.  Adjusting Insulin Dosages:

*for OLDER TEENS/YOUNG ADULTS ONLY, with the guidance of caregivers and/or health care team.*
(Note: This is an advanced skill, a challenge for many adults to master, so caution is needed to maintain reasonable
expectations.)

a. Reviews log book / blood glucose data regularly.

b. Notices trends in highs and lows:

i. at certain times of the day.

ii. with certain activities.

iii. on certain days of the week (ex. weekends vs. weekdays).

c. Adjusts insulin dosages accordingly.
(For more information, see Blood Glucose Management documents:

Level1/BG Management/Conventional Pattern Adjustment
Level1/BG Management/MDI Pattern Adjustment
Level2: articles under “BG Management – Injections” or “BG Management – Pumps”
Level3: pump insulin adjustment articles under “BG Management”

d. Monitors results of change in insulin dosages.

e. Repeats 1-4 (directly above) as needed.


What If These Steps Are Too Big?

If a step seems unmanageable for your child or teen, or if you have been trying to teach a given step without success, consider ways to break that skill down into smaller component steps, and then teach one of those sub-steps at a time.


For additional task analyses, see:

Part 3: Blood Glucose Monitoring and Treatment
Part 5: Managing Insulin Pumps
Part 6: Carbs and Exercise


Any questions? Comments? Feel free to Contact Us.


The above information was reviewed for content accuracy by clinical staff of the Alberta Children’s Hospital Diabetes Clinic.

This material has been developed from sources that we believe are accurate, however, as the field of medicine (in particular as it applies to diabetes) is rapidly evolving, the information should not be relied upon, as it is designed for informational purposes only. It should not be used in place of medical advice, instruction and/or treatment. If you have specific questions, please consult your doctor or appropriate health care professional.


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