ASSISTANCE WITH INSULIN INJECTION TRAINING

HYPERGLYCEMIA (High) 
 HYPOGLYCEMIA (Low)
Signs/Symptoms of Hyperglycemia:
•	Headache
•	Blurred vision
•	Thirsty
•	Tired/Weak
•	Increased Urination
•	Increased Pulse

If a resident is experiencing the symptoms of Hyperglycemia you should check his/her BG and report to the nurse if the BG is over 300.

Signs/Symptoms of Hypoglycemia:
•	Confusion
•	Pale/Clammy Skin
•	Sweating
•	Dizzy
•	Unclear Speech
•	Weakness 

If a resident is experiencing the symptoms of Hypoglycemia you should check his/her BG if below 70 and the resident can swallow give them something with sugar such as juice, a piece of candy etc. 

If they have an order for Glucose, call the nurse and ask if it can be given. 

If the resident is unable to swallow or is semi-conscious call 911 and the nurse. Resident should eat some protein 20-30 minutes after the juice etc.

TYPES OF INSULIN
Insulin is administered in Units and is injected into subcutaneous tissue. There is short-acting Insulin and long-acting Insulin. 
Short Acting Insulin  The resident’s BG is checked and there will be an order from the Physician instructing how much Insulin should be given according to the Resident's BG. For example: for BG of 150-200 give 5 Units, 200-250 give 6 Units etc.
Long Acting Insulin (ex: Lantus) is usually given once a day and usually in the evening.

DIABETIC DIET
The Diabetic diet consists of a low carbohydrate, low fat and no concentrated sweets diet. Carbohydrates turn to sugar in the blood and therefore should only be in small amounts for Diabetics.  Examples of concentrated sweets include cake, cookies, candy, fruits and juices just to mention a few. Examples of carbohydrates are potatoes, rice, bread and pasta. Diabetics should eat a diet high in protein. Examples of proteins are meat, cheese, eggs, nuts, peanut butter and beans.
Diabetics should eat 5-6 small meals a day, which should consist of 2-3 regular meals and 2-3 snacks. One of the snacks should be eaten before bed. Their snacks should be a protein snack.  For more information regarding Type 1 and 2 Diabetes and the actions of insulin in the body please refer to the ADA (American Diabetic Association).

PROCEDURE FOR GIVING INSULIN
Important: When assisting with giving Insulin, Medication Technicians MUST verify the type of Insulin, the dose, the correct Resident and that the Insulin Pen is dialed correctly!
Assisting with Insulin should be taken very seriously. Giving the incorrect type, or dose can be life threatening.
Insulin is administered in Units into the subcutaneous skin usually in the abdomen, or thighs, or both. The site should be rotated so as to not cause scarring of the tissue. The nurse should set up a chart for rotating sites that can be initialed each time Insulin is administered.
Steps:
1.	Gather equipment: Gloves, alcohol wipes, site rotation chart, Insulin Pen, MAR. Ensure that the proper test strips are being used for the respective meter and check expiration dates.

2.	Wash hands, don gloves

3.	Verify correct type Insulin Pen, dose and Resident with MAR

4.	Dial the Pen and verify it is correct.

5.	Cleanse correct site for administration (according to the rotating site chart) with alcohol wipe in a circular motion from the inside area to the outside area and be sure the area is dry before performing the stick. 

6.	Grasp Insulin Pen, attach needle.  Place Pen flat on skin (can use hand over hand technique with resident) and press button to inject.  

7.	Observe for a few minutes for side effects

8.	Document Insulin dos/type and site given. 

ASSISTANCE WITH INSULIN TEST
1.	List 6 symptoms of Hyperglycemia:
2.	List 6 symptoms of Hypoglycemia:

Circle the correct answer:
1.	 Insulin Is measure in:
a.	Milliliters
b.	Units
c.	Centimeters

2.	Insulin is administered:
a.	Orally
b.	Intramuscularly
c.	Rectally
d.	Subcutaneously

3.	When administering Insulin, the Medication Technician should:
a.	Rotate injection sites
b.	Insert needle slowly and remove slowly to prevent pain
c.	Cleanse area with alcohol wipe in a circular motion starting from the outside area to the inside area. 

4.	If a diabetic resident is complaining of weakness seems confused, and their skin is pale and clammy, what should you do?  
a.	Take them for a walk.  They will feel better 
b.	Get them to lie down and check on them later
c.	Check their BG, if low and they are able to swallow give them a glass of juice, or a piece of candy.  If they have glucose gel or lozenges, call nurse to get permission to give.  
d.	Pacify them, or ignore them.  They are just being dramatic. 

5.	What equipment/materials are needed in order to assist with administering Insulin? 
a.	Just the Insulin
b.	Syringe, needle, Insulin, MAR
c.	Gloves, alcohol wipes, MAR, Insulin Pen, rotating injection site chart and another Medication Technician
d.	Don’t worry, you can stop and get what you need after you get the resident and start the procedure. 
 
6.	When preparing to assist with insulin, you should: 
a.	Check MAR and Insulin pen, then administer for correct type and dose.
b.	Verify correct Resident, type of Insulin is correct, Insulin Pen and dose with the MAR and another Medication Technician present. Then check for the correct injection site from the site chart. 
c.	None of the above.

7.	When preparing the site for injection you should: 
a.	Just inject it.  No preparation is needed
b.	Give the intended site a swipe with an alcohol wipe
c.	Using an alcohol wipe, going in a circular motion, start from the outside to the inside of the area. 
d.	Using an alcohol wipe going in circular motions, start from the inside moving towards the outside of the area.   

8.	A Diabetic’s diet should consist of: 
a.	3-4 large meals a day
b.	Have equal amounts of carbohydrates, concentrated sweets, and protein. 
c.	Eat whatever and whenever they want.  They take Insulin, so it doesn’t matter
d.	No concentrated sweets, low carbohydrate, low fat, 5-6 small meals a day. 

ANSWER KEY
1.	headache, blurred vision ,thirsty, tired/weak, increased urination, increased pulse
2.	confusion, pale/clammy skin, sweating, dizzy, unclear speech, weak
Multiple Choice:
1.	C
2.	D
3.	B
4.	C
5.	C
6.	C
7.	D
8.	D