The pancreas (Refer to Chapter 2)

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1 The pancreas (Refer to Chapter 2) In Type 1 diabetes, the body does not produce insulin. To understand diabetes; and in particular Type 1 diabetes, you must first of all understand how insulin works. What is insulin and where does it come from? Insulin is a hormone made in a gland in the body called the pancreas. The pancreas is located behind the stomach and attached to the small intestine. Diagram 1a The pancreas has many different cells within it. The insulin making cells in the pancreas are called beta cells. Diagram 1b Why is insulin necessary for the body to remain well? The carbohydrate food we eat is digested and converted into a substance called glucose (a type of sugar). Examples of carbohydrate foods include: bread, milk, fruit, soft drink, honey & lollies. Once digested, the glucose is absorbed into the bloodstream. The bloodstream then carries the glucose to the cells of the body where it is used for energy or stored for future needs. Insulin is the hormone needed to move the glucose from the bloodstream into the cells. Insulin is the key which opens the door of the cell, allowing glucose to flow inside. Without insulin most of the organs cannot take up glucose. Diagram 1d In Type 1 diabetes the beta cells in the pancreas are destroyed and do not produce or cannot make enough insulin to meet the body s needs. When there is not enough insulin in the body the glucose stays in the bloodstream. The blood glucose level rises very high because it cannot move into the cells. The body tries to clear the glucose from the bloodstream by releasing glucose into the urine. Chapter 2 1

2 Diagram 1e When glucose cannot be used for energy the body uses fat instead. If fat is used for energy, some harmful substances called ketones begin to build up in the blood. The ketones that build up will make the person with diabetes very sick. Diagram 1F Without insulin the body cannot function properly and will become seriously unwell. Why does Type 1 diabetes happen? The actual reason is still unclear but what we know is: The body s immune system, which normally protects us from infection, has made a mistake. The immune system seems to have been tricked into thinking that the beta cells are a germ and starts to make antibodies which attack and destroy the Beta cells. Beta cells are important because they produce the hormone called insulin. It is important to understand that only the beta cells are being attacked by the immune system. The rest of the pancreas is working as normal. We can detect the mistake made by the immune system by performing a blood test that shows the presence of certain types of antibodies of type 1 diabetes. These are the antibodies that attack the beta cells in the pancreas. The beta cells are often destroyed slowly over time unbeknown to anyone, as your child does not look sick. It is not caused by anything you or your child has done - you could not have prevented this from happening. As the beta cells decrease in number the body finds it harder to produce enough insulin for the body s demand. It is at this point your child may have had symptoms like: unquenchable thirst the constant need to go to the toilet weight loss At the time of diagnosis the body s insulin is replaced by an insulin injection. Insulin stops the above symptoms and over a short period of time your child will feel better again. The insulin injected is artificial but identical to human insulin. Insulin cannot be given as a tablet as it would be destroyed by stomach acids. So what is the honeymoon period? The honeymoon period often occurs shortly after diagnosis. When insulin treatment is started, the pancreas is able to rest and recover to some degree, but not enough to produce all the insulin the body needs. For a time, your child s pancreas may continue to produce up to half or more of the insulin needed by the body, and this period is called the honey moon period. This can be a period where your child may require small doses of insulin. Unfortunately, over a period of time the pancreas becomes unable to produce any insulin and all of the body s need for it must be met by injection. (manual pg 6) Chapter 6 2

3 Insulin Where does it come from? (Refer to ) Insulin in a person with type 1 diabetes is replaced by an injection of manufactured insulin. Manufactured insulin is made in a laboratory and is identical to human insulin. It is not made from animal products. Insulin is essential for survival There is never a time the body should be without insulin There is no alternative treatment to insulin Insulin is a hormone made of protein. If given as a tablet it would be destroyed by the stomach s acids. There are many different types of insulin available. Those frequently used for children and young people are: Insulin treatment (The educator will underline the insulin types you are on) 1 Rapid-acting insulin Begins to work immediately within 5 to 15 minutes, after being injected The maximum effect is between 1-3 hours Lasts for up to 3 to 5 hours Clear solution 2 Short-acting insulin Begins to work within 20 to 30 minutes of being injected The maximum effect is between 2 to 4 hours Lasts for up to 5 to 8 hours Clear solution. 3

4 3 Intermediate-acting insulin Begins to work within 1 to 2 hours of being injected The maximum effect is between 4 to 12 hours Lasts up to 16 to 24 hours Cloudy solution 4 Long-acting peakless insulin Long-acting insulin provides a steady level of insulin over 24 hours Clear solution, unlike other long-acting insulin. Usually, when diabetes is first diagnosed the insulin will be given before breakfast and before dinner. A mix of insulin is commonly used e.g a rapid or short acting insulin added with an intermediate acting insulin. The insulin coverage over 24 hours will look like this. 4 For other insulin regimes please refer to the diabetes manual.

5 Insulin sites and rotation (Refer to ) Insulin is injected into the fat layer just under the skin. Insulin treatment It is important to rotate injection sites and look at the skin s surface as this will help to: a) prevent lumps from forming b) ensure adequate absorption of insulin The injection sites that we recommend for use are: Injection sites should be checked daily for: lumps hardness pain redness (or other colour changes) infection If you find any skin changes please contact your diabetes educator and avoid using the injection site again until it has been looked at. NOTE: Hard lumps or other changes in injection sites may take up to one year to disappear. In this time the injection site should not be used. The preferred sites to be used are the stomach and hip. Exercise increases insulin absorption, the arms and legs may need to be avoided on very active days with lots of sport. Some children have little to no fat tissue in the stomach area. If this is the case the stomach area should not be used. Your diabetes educator will discuss which sites are best for you. 5

6 Insulin administration (Refer to ) Storage Unopened insulin needs to be stored in the fridge. Opened insulin needs to be stored in a cool dry place and can be used for up to one month. As soon as one month has past, the insulin in use needs to be discarded as it will no longer work effectively. Insulin may loose its effectiveness and should be discarded if: exposed to direct sunlight exposed to direct heat (eg left in a car) frozen vigorously shaken Drawing up When drawing up insulin from vials, air needs to be injected into the vial to avoid problems with suction and airlocks. Follow the steps below to learn the process of drawing up insulin: 1 Insulin treatment Wash hands. 2 3 Check the insulin vials name, appearance and expiry date: When opening a new vial, write today s date & throw out one month later. Mix the cloudy insulin thoroughly by rolling the bottle in the hands ten to twenty times until it looks completely mixed. Mixing the insulin is important because if the insulin is not mixed well you may draw out very dilute or very concentrated insulin and get the wrong dose. 6

7 4 Open a new syringe Alcohol wipe the top of the vial Inject air into the bottle of equal to the dose of required Remove the needle. Alcohol wipe the top of the vial Inject air into the bottle of equal to the dose of required Leave the syringe in the bottle and turn it upside down. Pull back the plunger of the syringe to draw up the dose of Make sure you get rid of any air bubbles! Check that you have mixed the Insert the syringe and pull back the plunger to obtain the correct dose. (If you draw back too much insulin here, you must discard the syringe and start over again). You cannot push the insulin back into the bottle as the ratio of long and short acting insulin will be affected. 8 The insulin is now ready to inject. 7

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