INSULIN

What is insulin & how does it work?
Insulin is a hormone made by the pancreas, which lies behind the stomach. Hormones do special work in the body. Insulin’s special job is to help our body use glucose, from the food we eat, to give us energy to do all the things we like doing. Insulin is like a key unlocking the doors of our body cells to let the glucose in.

When you have type 1 diabetes, the pancreas stops making insulin. When this happens, there are no keys to unlock the doors to your cells, so they can’t get the glucose they need.

You can’t take insulin as a pill, the only way to give insulin is by injection or an insulin pump. Read more info on diabetes and how insulin works.

Giving your insulin
Syringes (needles), pens and pumps are three different ways that you can give your body the insulin it needs.

A syringe for giving insulin comes with a small needle on the end. You use the syringe and needle to draw up your insulin from a bottle. Syringes come in different sizes and have numbers written on the side so you can check your insulin dose. To give your insulin using a syringe, you have to pinch up the skin on your tummy, put the needle just under the skin and push the plunger at the end of the syringe to get the insulin into your body. You can use syringes for mixing different types of insulin. You should only use a syringe once.

A pen looks more like a texta that you fill with insulin from a penfill. You have to put a needle on the end of the pen and change the needle every time you give your insulin injection. With an insulin pen, you dial up your dose and press a button to give your insulin. Many kids like to use pens because they don’t look like a syringe, are easy to carry and easy to use. Pens can't be used for mixing different insulins. If you use a pen, it’s a good idea to know how to use syringes to give your insulin in case your pen doesn’t work properly.

An insulin pump is another way to give insulin. It is like a small computer that you load with insulin and program to give you small amounts all the time, and extra doses when you eat which is what your pancreas would do if you didn’t have diabetes. The pump is set to give the body insulin through thin plastic tubing connected to a small plastic tube (cannula) or a small needle. This tube or needle is placed just below the skin of the tummy or in your lower back where it stays for about three days. The pump is worn outside the body, in a pouch or on your belt (like a pager). If you use an insulin pump, you have to wear it all the time and change the tubing and cannula or needle every three days. It is important to also know how to use pens and syringes to give insulin in case your pump doesn’t work properly.

Some things to help you with your injections (needles)

Sometimes kids with diabetes can be nervous about giving needles. Here are some special things to help you – it’s a good idea to talk to your diabetes team if you’re worried. Mum, Dad or someone at home will help you!

Inject Ease®
You draw up your insulin as you usually do, then put the syringe into the Inject-Ease. You won’t be able to see the needle and when you press the button on the side, the needle goes into your skin.

PenMate®
You can use this with your NovoPen 3 and it works in the same sort of way as the Inject Ease.

Insuflon®
This is a small plastic tube that is placed under the skin in your tummy (where you would usually do an injection) for up to 4 days. You can draw or dial up your insulin in a syringe or pen and put the needle into the rubber membrane at the end of the plastic tube, instead of straight into the skin.

Jet Injection Devices
These have no needle and push the insulin under your skin with air pressure. The injection will still hurt a bit and we don’t usually advise children to use it because it’s not painless it may not help you to get over your needle worries. Also the insulin you’re having may not be absorbed and won’t work properly.

Where to inject
Most kids are taught to inject insulin into their tummy because the insulin works more quickly and evenly here than from other parts of the body. If you inject into your tummy, don’t inject into the same spot every day, otherwise you get lumpy bits and the insulin won’t work properly.

You can also inject insulin into other parts of the body. Have a look at the picture.

Some people also use the top of their legs to inject their insulin just before bed so the insulin works slowly overnight. Don’t inject into your legs when you are going to be active (like walking, running or playing sport) because this makes the insulin work really quickly and you might have a hypo.

It is important to inject into the fat just under the skin, this is why other parts of the body that have less fat (like the arms) are not usually used. Talk to your doctor or diabetes educator about where to inject.

Where to keep your insulin
It is really important that your insulin is kept somewhere safe that’s not too hot or cold. If you don’t, it can go off and not work properly.

Bottles and penfills of insulin that you are not using should be stored in the fridge until the use by date. They shouldn’t be frozen and if they are, they have to be thrown away.

The insulin bottle or penfill you are using can be kept at out of the fridge somewhere safe that’s not too hot or cold. There are special packs you can buy to protect your insulin when you are in hot or cold places. It is best to take your insulin out of the fridge before you use it because cold insulin can sting when you inject it. You should throw insulin away if it has been opened for more than 3-4 weeks. Remember don’t shake up your insulin too much because this can damage it and it won't work properly. Make sure you have spare bottles or penfills in case you break one.

Meters
To test your BGL you need a blood glucose meter. There are lots of different meters for you to choose from. You need a drop of blood, usually from a finger prick (depending on which meter you are using). You can download information from some meters on to a computer so you can see what your BGLs are doing from day to day. Your diabetes educator will help you to choose a meter that’s right for you.

Click here for info on current meters.

It is important to look after your meter so that it works properly. Keep it clean, try not to drop it and make sure it doesn’t get too hot or cold. There are special packs you can buy to protect your meter when you are in hot or cold places.

Finger Prickers / Lancets
A finger pricker or lancet is used to get the drop of blood to test your BGL. There are lots of different types and you can change how deep they go into your finger or skin so that it doesn’t hurt too much. When you prick your finger, try to do it on the sides at the top of your finger not on the soft part at the tip, or your fingers will get very sore. It is also important to change where you do your finger prick each time. Don’t forget to change the lancet (sharp bit) of your finger pricker before it gets blunt otherwise it might hurt or not work properly. Your diabetes educator will help you choose a finger pricker and show you how to use it.

Testing Strips
Blood glucose test strips
There are special testing strips that you need to use with your blood glucose meter. Once you have pricked your finger, you should carefully place the drop of blood on the special spot on the end of the testing strip. Every meter has its own testing strips that you use once and then throw away carefully. Everyone with diabetes should join the National Diabetes Services Scheme (NDSS) to be able to buy cheaper strips.

Ketone test strips
When your BGLs are high (more than 15 mmol/l) or when you are sick it is important to test for ketones. Ketones are a sign that things are out of balance and can make you even more sick. There are two ways you can test for ketones – by testing your blood or by testing your urine.

Blood – There is a meter you can get to test your blood for ketones. You can use the same drop of blood to test your BGL and test for ketones, so you only need to prick your finger once. There are different strips to test your BGL and for testing ketones.

Urine – If you don’t have a meter that tests for ketones, you need to test your urine (wee) for ketones. There are special strips for this. To do this test, hold the strip and wee on to it when you go to the toilet. It might sound yucky, but it is really important.

Testing Diary / Record Book
It is important for you to write down your blood glucose levels in a special book that you can get from your diabetes educator. This book can help you, your family and your diabetes team to work out how much insulin you need and any changes you need to make to manage your BGLs.

Hypos
A hypo is when your blood glucose level goes too low. When this happens you might feel:
• Sweaty
• Shaky
• Sleepy
• Cross
• Weak
• Like you can't concentrate
• Headache-y
• Like crying

Everyone is different, you need to know how you feel when you have a hypo. Hypos can be caused by lots of different things, like:
• Exercise or sport
• Not eating enough at snacks or meals
• Skipping meals
• Too much insulin

Common times for hypos are just before recess or lunch, during and after sport, but remember they can happen at any time.

When you have a hypo you need to quickly eat or drink something sweet straight away like:
• 125 – 200ml fruit juice (1 small popper) or
• 1/3 – ½ can regular soft drink (not diet) or
• 3 teaspoons honey or sugar or
• 4 large or 7 small jelly beans

Then eat something else to stop the hypo from coming back, like:
• A piece of fruit or
• A slice of bread or
• Two plain sweet biscuits or
• A glass of milk or
• If it's just before recess, lunch or a meal, eat or drink something sweet then eat your meal or snack

Don’t forget to always carry hypo foods with you and always tell an adult when you have a hypo. Make sure you don’t ignore a hypo even if you are worried about making a fuss or having everyone look at you. No one likes to be embarrassed, but ignoring a hypo can make you feel worse and can be more embarrassing if you don’t treat it.

Highs & Sick Days
Sometimes your BGLs can go too high. This can be when you:
• Feel sick or unwell
• Are stressed, worried or excited
• Are less active than usual
• Eat more than usual
• Don't have enough insulin in your body (eg. you forgot your insulin injection or didn't give the right dose)
Sometimes your BGLs can go high for no reason at all.

If your BGL is above 15mmol/L and you are feeling OK, you can enjoy all of the fun things that your friends are doing, but don’t play really active sports like football until your BGL comes down. Drink plenty of water and do another test if you are not feeling well.

If your BGL is above 15mmol/L and you are feeling sick, you might have ketones. High BGLs and ketones can make you really unwell and give you a tummy ache, make you feel thirsty and want to go to the toilet a lot. This means that things are out of balance in your body. When you feel like this, you need to tell mum, dad or someone at home how you feel, test your BGL more often, drink plenty of water and have some quiet time. When your BGLs are high and you have ketones, you need extra insulin – mum or dad will help you with this. It's really important that you and your family talk to your diabetes educator about what to do for sick days.

ID
Don't forget to wear or carry something that says you have diabetes, like a necklace, bracelet or diabetes ID card. This is important just in case someone doesn't know you have diabetes and you have a hypo or get sick. For some ID ideas click here.