Question

Record yourself providing a teaching demonstration to a 3-year-old child newly diagnosed with type 1 diabetes mellitus who will be started on insulin. How will you teach this child to administer their insulin dose? Recording should be no longer than 2 minutes.

Answer 1

Type 1 diabetes is a disease in which the body does not make enough insulin to control blood sugar levels. Type 1 diabetes was previously called insulin-dependent diabetes or juvenile diabetes.

When a child has T1D, the immune system attacks and destroys cells in the pancreas called beta cells. Pancreatic beta cells produce insulin, the hormone we need to turn food into energy.

Without enough insulin, the amount of sugar (or glucose) in the blood rises to dangerous levels. This can cause long-term complications such as kidney failure, heart disease, lower-limb amputations, and blindness in adulthood. That's why kids with T1D have blood glucose levels checked throughout the day and night to help keep the sugar levels within target range. Using a lancet, you'll likely prick your child's fingertip for a drop of blood six or more times a day, and place it on a special test strip in a blood glucose meter. Based on that reading, you'll know how much insulin your child needs to keep blood sugar levels in range.

The basics of Shots and pumps

You can give your child insulin in a few ways, depending on what works best for both of you.

The oldest method is through multiple daily injections with a syringe or insulin pen, which is a disposable needle tip placed at the end of a marker-shaped device that contains a pre-filled insulin cartridge.

An alternative to injections is an insulin pump, a beeper-sized computerized device often worn on a belt or in a pocket. It delivers an ongoing low dose of insulin through a small tube inserted into your child's body through a needle. The tube is then taped into place and the needle removed. An insulin pod pump combines the tubing and insulin cartridge of a pump into one device that adheres directly to the body.

Whenever a child wearing a pump eats or has an elevated blood sugar level, he pushes a button on the pump to deliver an extra amount of insulin, called a bolus. (Parents or caregivers will need to do this for younger children.) The site of the pump's tube needs to be changed (usually by a parent) every two to three days to prevent infection, and also because it's harder to control glucose levels when insulin is always infused into the same area. Shots are a less expensive route and require less education and training than what's needed for proper use of the computerized insulin pump, according to the Harvard-affiliated Joslin Diabetes Center in Boston.

On the other hand, a pump offers more flexibility because it continuously delivers insulin and only requires one needle stick every two to three days when the site is changed. One downside to a pump is having something physically attached to the body, which some people don't like.

Both the injections and pump require education and understanding of how to avoid hypertrophy, which is when insulin doesn't absorb very well. Hypertrophy develops if insulin is constantly given in the same spot.