Diabetes Aide Training

Complete all of the following modules:

As you complete this training course the RN responsible for delegating the task of insulin administration should be available to discuss the content and answer your questions.

  1. Intro
  2. Diabetes Basics
  3. Nutrition, Carbohydrate Counting, and Physical Activity
  4. Blood Glucose Monitoring
  5. Insulin Basics
  6. Methods of Insulin Administration
  7. Hypoglycemia
  8. Glucagon Administration
  9. Hyperglycemia & Ketones
  10. Documentation
  11. Universal Precautions

Methods of Insulin Administration

injecting into subcutaneous layer

Insulin is administered by injection into the subcutaneous tissue, which is the fat layer right underneath the skin.

There are 4 main areas of the body where insulin is injected:

  • Abdomen (avoid 2 inches around the navel)
  • Upper arms
  • Thighs
  • Buttocks
Rotating injection sites is very important. Be sure to inject in a new spot each time.

Watch the video on rotating injection sites, available on the BD Company’s website . BD is a medical technology company and manufacturer. They produce medical supplies, devices, and other products, including insulin syringes and needles for insulin pens. After viewing and reading the information from BD’s website, please review the information you learned with the RN assisting you with your training.

Administering Insulin by Vial and Syringe

Review the steps in the table to identify how to draw up a dose of insulin using a vial and syringe. Then watch the video. The video demonstrates the steps and will help you prepare to practice and to safely perform this task with your delegating RN.

Follow these steps to safely draw up a dose of insulin using a vial and a syringe.

  • Identify appropriate location to perform procedure.
    		•  This should be a place that provides privacy.
  • Wash your hands.
    		•
  • Gather supplies:
    Gloves, insulin vial, insulin syringe, alcohol wipe, cotton ball, and sharps container.
    		•  There are several types of syringes, discuss with the RN which type you will use for each person:
    • Size: 1/3 cc, ½ cc, or 1 cc
    • Marked as: ½ unit, 1 unit, or 2 unit increments
  • Check the expiration date on the insulin vial and the day it needs to be discarded.
    		• Vials should be discarded 28 days after opening.
  • Verify the right person with diabetes.
    		•
  • Verify the insulin dose.
    		•
  • Put on gloves.
    		•
  • If you are using cloudy insulin (NPH or pre-mixed insulin) roll vial between the palms of your hands until evenly mixed.
    		•  Do not shake the vial as this may create air bubbles.
  • Wipe top of insulin vial with the alcohol wipe and let it dry for a few seconds.
    		•
  • Pull the syringe plunger down to the mark equal to the amount of insulin needed.
    		•
  • Push the needle through the center of the rubber top on the insulin vial.
    		•
  • Push down on plunger to push air into vial, leave needle in vial.
    		•
  • Turn insulin vial and syringe upside down.
    		•
  • Pull the plunger down to correct number of insulin units.
    		•
  • Look for air bubbles.
    		•
  • If you see bubbles, tap syringe to raise bubbles to top, and then push bubbles back into bottle. Pull plunger back down to correct number of units.
    		•  Repeat as needed until bubbles are out of syringe. Bubbles will not hurt the person but will take the place of insulin in syringe so the person does not get the correct dose.
  • Double check the correct number of units, then remove the needle from the vial.
    		•
  • Select the appropriate injection site.
    		•  Involve the person with diabetes if appropriate.
  • Clean skin with alcohol wipe, let dry for a few seconds.
    		•
  • Insert the needle into the skin.
    		•  Review with the RN which technique to use for each person with diabetes:
    • 4 mm or 5 mm needle: insert at 90 degree angle with no skin pinch.
    • 6 mm or 8 mm needle: insert at 90 degree angle with a small skin pinch.
  • Push the plunger all the way down. Count to 10.
    		•
  • Remove needle, apply gentle pressure with cotton ball as needed.
    		•
  • Dispose of syringe in a Sharps container.
    		•  Do not recap the syringe.
  • Remove your gloves.
    		•
  • Document: blood glucose result, insulin site, and injection site.
    		•

    Administering Insulin by Pen

    Review the steps in the table to identify how to give a dose of insulin using an insulin pen. Then watch the video. The video demonstrates the steps and will help you prepare to practice and to safely perform this task with your delegating RN.

    Follow these steps to safely give a dose of insulin using an insulin pen.

  • Identify appropriate location to perform procedure.
    		•  This should be a place that provides privacy.
  • Wash your hands.
    		•
  • Gather supplies:
    Gloves, insulin pen, pen needle, alcohol wipe, cotton ball, and sharps container.
    		•  If the pen uses an insulin cartridge, that needs to be changed every 28 days.
  • Check the expiration date on the insulin pen and the day it was opened and when it needs to be discarded.
    		• This discard date varies based on the type of insulin in the pen.
  • Verify the right person with diabetes.
    		•
  • Verify the insulin dose.
    		•
  • Put on gloves.
    		•
  • Remove the cap from the pen.
    		•
  • If using a cloudy insulin (NPH or a pre-mixed insulin) roll the pen 10 times then rotate it 10 times until insulin is evenly mixed.
    		•
  • Wipe top of insulin pen with alcohol wipe and let it dry for a few seconds.
    		•
  • Peel paper off end of pen needle and gently twist needle firmly in place.
    		•
  • Remove outer and inner needle caps; place on table.
    		•
  • Dial or turn knob to "2" to prime pen with 2 units of insulin.
    		•  Prime pen before every injection to ensure insulin is flowing through the needle.
  • Hold pen with needle pointing up. Push on plunger and watch to be sure that small drops or a stream of insulin comes out the end of the needle. Repeat if needed until insulin comes out.
    		•  A new pen usually requires more than one priming of 2 units.
  • Check to make sure the dial is back on "0".
    		•
  • Dial or turn knob to the number of units needed. Double check that you have the correct number.
    		•
  • Select the appropriate injection site.
    		•  Involve the person with diabetes if appropriate.
  • Clean skin with alcohol wipe, let it dry for a few seconds.
    		•
  • Insert the needle into the skin.
    		•  Review with the RN which technique to use for each person with diabetes:
    • 4 mm or 5 mm needle: insert at 90 degree angle with no skin pinch.
    • 6 mm or 8 mm needle: insert at 90 degree angle with a small skin pinch.
  • Push the plunger all the way down. Count to 10.
    		•  The dial should have returned to "0".
  • Remove needle, apply gentle pressure with cotton ball as needed.
    		•
  • Remove needle from the end of the pen.
    		•
    • If you are using a safety needle, twist the needle off the end of the pen yourself.
    • If you are using a patient needle, give the pen to the person with diabetes and have him/her remove the needle from the pen if possible.
  • Dispose of needle in a sharps container.
    		•  Do not recap the needle.
  • Replace the cap on the pen.
    		•
  • Remove your gloves.
    		•
  • Document: blood glucose result, insulin site, and injection site.
    		•

    Administering Insulin by Pump

    An insulin pump provides another way to deliver insulin as an alternative to the vial and syringe or insulin pen methods. The pump is filled with a 2-3 day supply of rapid-acting insulin, which is delivered by a small tube placed just underneath the surface of the skin. A pump is not surgically implanted, but rather is operated completely by the person with diabetes.

    Watch the video, it demonstrates the steps for working with a pump and will help you prepare to practice and to safely perform this task with your delegating RN.

    Pump Delivery Methods

    The pump delivers insulin by two methods:

    • Basal Rate
    • Bolus

    Basal Rate

    Basal Rate is a continuous infusion of insulin that is delivered 24 hours a day to control blood glucose levels between meals and overnight.

    Bolus

    Bolus is an extra amount of insulin that is given immediately before or right after meals to bring down the blood glucose level that normally goes up after eating. Sometimes a bolus is given when snacks are eaten or to correct a high blood sugar between meals. Any extra boluses will be given at the direction of the delegating RN.

    Pump Components

    Components of an insulin pump include the following parts:

    • Pump
    • Reservoir
    • Infusion Set

    Pump

    Pump is a device that electronically directs the administration of insulin to a person. It is a battery operated unit normally worn on a belt or waistband, but can be tucked inside clothing or carried in a small pouch. One type of insulin pump involves a "pod" worn directly on the skin; the "pod" holds the insulin.

    Reservoir

    Reservoir – a large syringe located in the pump that holds enough insulin for about 2-3 days.

    Infusion Set

    Most often the infusion set is comprised of two parts, tubing and a small plastic cannula. The tubing connects the insulin reservoir to the cannula. The cannula is a tiny plastic tube inserted into the skin, often in the abdomen or hip area, but sometimes in the upper arm or thigh. The cannula is inserted with a needle. The needle is removed immediately after the cannula is in place in the body. Also know that there are other types of infusion sets. One other type does not use a cannula but instead uses a short needle that stays in the body and is connected by tubing to the reservoir. The insulin pump that involves a small "pod" which is placed on the skin does not need tubing. It is operated by a handheld device that electronically communicates with the pod by radio frequency.

    Check the following:
    • The infusion site before giving a bolus of insulin to make sure the infusion set is dry and intact (attached securely).
    • The infusion set to make sure it is attached to the reservoir in the pump.

    Report any of the following situations to the RN immediately

    Any of these situations may mean the insulin is not infusing correctly!

    • The cannula (or infusion set) has pulled out.
    • Tape around the edge of the infusion set is pulling up (this may make it easier for the set to fall out or to let bacteria under the skin, increasing the risk of infection around the site).
    • The skin or tape around the site is wet or feels damp; or you smell insulin around the site (the cannula may have come out).
    • Swelling or redness at the infusion site.

    Remember

    You should never change the infusion set (cannula, reservoir, or tubing). Call the RN immediately if there is a problem with the pump or any of the other components.

    Giving a Bolus

    Keep in mind there are many types of pumps available on the market and they all work differently. It is important that you have directions for the specific pump you will be assisting with. Your delegating RN should show you how to give a bolus with the pump and how to troubleshoot basic pump functions. The RN is responsible to work with you to make certain you can competently and safely operate the pump. The RN will go through the steps for giving a bolus with the pump. This involves:

    • Checking the Diabetes Medical Management plan (DMMP) or physician orders to find out if the person you are working with needs his/her bolus before or after each meal.
    • Entering the pre-meal blood glucose level into the pump.
    • Entering the grams of carbohydrate anticipated to be eaten or actually eaten at the meal.
    • Remember to always double check that the correct blood glucose result and carbohydrate grams are entered into the pump before giving the bolus.
    • Watch the pump screen to be sure that the entire bolus is delivered.