Starting Insulin Injections

Transcription

1 Starting Insulin Injections Other booklets in this series: see How to use this series How Your Body Works. Gestational Diabetes What is It? Why and How Do We Treat It? Eating for Gestational Diabetes Starting Insulin During Pregnancy Care of Yourself and Baby After Birth CPIC Innovation Project: Diabetes in Pregnancy

2 What does insulin do? insulin Insulin is made by your pancreas. pancreas Insulin is released into the blood when you eat. Insulin travels around in the blood with the sugar, and goes to the muscle cells. Insulin is like the key to the cell door... it helps sugar pass out of the blood and into the muscle cell. 2 2

3 Why do women need to make more insulin in pregnancy? Pregnancy hormones made by the placenta help baby to grow. During pregnancy, women have to make more insulin than usual because the pregnancy hormones stop insulin working properly. For some women, eating good food is not enough to keep blood sugar at safe levels. If you can t make enough extra insulin yourself, you need to inject it. It is the same as the insulin you make in your body. It will not harm your baby. 3

4 Insulin Injections Insulin injections help to keep blood sugar levels normal and avoid problems for you and your baby. Types of insulin Your records will help the doctor decide which types of insulin you need. There are long acting (background) types and quick acting (meal) types. You need to keep checking your blood sugar levels so the insulin can be changed as your pregnancy goes on. Go to the clinic at least once a week. Doctors and midwives will manage your insulin when you are in labour. Once baby is born, the extra insulin is not needed, so you stop injecting. 4

5 How do I give myself the insulin injection? Your clinic nurse, health worker or diabetes educator will teach you to give yourself the injections. Starting with a small dose, amounts are increased gradually (bit by bit) until blood sugar levels are less than 5.5 before breakfast less than 7.0 two hours after meals. You will use an insulin pen. The insulin is injected into the soft skin on your tummy or top of your leg. You need to put the needle into a different place each time - at least 2 cms (2 fingers wide) from the last injection site. See the dietitian to make sure your insulin and food match up. 5

6 Injection technique Wash and dry your hands carefully. Dial up the number of units to be given on the insulin pen. Pinch up a fold of skin, and gently insert the needle at a 90 angle. Keep the skin pinched up and push the button at the end of the pen until the dial comes back to zero. Hold the pen in place and wait for 5 seconds. Remove the needle and release the skin. If you see any blood or clear fluid (insulin), do not rub it. Just press down on the area for 10 seconds (count slowly to ten). 6

7 How to take care of your insulin (so it works properly) Don t let it get too hot (never leave it in the car or in the sun). Store spare insulin in the fridge on the middle shelf. Always check expiry or useby date before you open any fresh new insulin. Insulin in the pen will be OK out of the fridge for 4 weeks after you open it. After that, throw it away. Never freeze insulin Disposal of Needles Used sharp needles and lancets need to be put into a safe container - yellow sharps containers from the clinic OR - a ( hard plastic) puncture-proof container such as a juice or milk bottle. 7

8 Travelling Always put insulin in an insulated container (like an esky or thermos). Driving Check that your blood glucose level is 5.0 or more before you drive. It is not safe to drive if your blood sugar level is too low! [Hypoglycaemia] Keep a carbohydrate snack in the car (eg. dried fruit or dry biscuits). If you feel your blood sugar is low pull over and stop. Test your sugar if you have your monitor with you Treat the low blood sugar if less than 4.0 (see page 9). Do not start driving again until you feel normal. Check your blood sugar level again, to make sure it is 5.0 or above. Be at least 5 before you drive! 8

9 Hypoglycaemia = low blood sugar You can get low blood sugar levels if you inject insulin. Symptoms you can feel : headache irritable blurred vision anxious sweaty tingling around mouth hungry racing heart shaky weak or tired Hypos (low blood sugar) can be serious. If you don t treat a hypo, you can pass out/become unconscious. 9

10 Preventing hypos (low blood sugar) Matching insulin with carbohydrate food and exercise will keep your blood sugar levels good. To prevent hypos/lows: Have carbohydrate food at breakfast, lunch and tea (and snacks) Don t skip meals. (If you do miss a meal, don t take the meal-time insulin.) Carry extra carbohydrate food (bread or fruit) for snacks or when you do extra exercise. Take the right amount of insulin. Avoid alcohol. (Alcohol can also harm the baby s brain.) Check your blood sugar if you think it is low. If it is less than 3.5 you will need to treat it 10

11 How to treat a hypo (low blood sugar) Check your blood sugar level - If it is 3.5 or less: FIRST have fast-acting sugars to bring blood sugar up : a glass of soft drink, sports drink or cordial (not diet soft drink) seven jellybeans three pieces of barley sugar three teaspoons of sugar or honey (in a glass of water) Wait 15 minutes. If you still feel the same, or your blood sugar level is still below 3.5, have one more of the fast-acting sugars. THEN have a meal if it is time, or a snack : fruit bread a glass of milk Always carry some hypo treatment (jelly beans or sugary drink) and some extra carbohydrate snacks. 11

12 Insulin and exercise Heavy exercise is not recommended in pregnancy. If you are walking, your blood sugar can get too low if you walk for a long time with no carbohydrate snack. You should always carry some carbohydrate foods with you when you are exercising. See your diabetes team health worker, doctor, diabetes educator and dietitian. During pregnancy, you also need to see your pregnancy team. 12

13 Notes 13

14 Notes 14

15 Notes 15

16 How to use this series Gestational Diabetes Information Booklets Booklets in this series: How Your Body Works. Gestational Diabetes What is It? Why and How Do We Treat It? Eating for Gestational Diabetes Starting Insulin During Pregnancy After Baby is Born These booklets were designed to assist with diabetes in pregnancy education for women living in rural and remote indigenous communities. They have been produced as a component of the Northern Area Diabetes in Pregnancy Innovation Project, overseen by the State-wide Diabetes Clinical Network and funded by the Clinical Practice Improvement Centre, Brisbane. The booklets are intended for use by indigenous health workers, nurses and other relevant staff at a primary care level, with the support of a specialist diabetes team doctor, diabetes educator and dietitian. Specialist support may be accessible through visiting services or via tele-health. Early specialist referral is essential for women who already have type 2 or type 1 diabetes, and pre-conception management is desirable. Linked resources: The Gestational Diabetes information booklets are also designed to be used with the following Growing Strong resources developed by the Tropical Population Health Service: Healthy food in pregnancy Physical activity during and after pregnancy Alcohol, tobacco and other drugs during pregnancy and breastfeeding Morning sickness and other pregnancy issues Keeping food safe Other Growing Strong booklets on breastfeeding and infant nutrition are recommended for follow-up of women who have had GDM. Training: For training details on how to use the booklets for Diabetes in Pregnancy, contact Bronwyn Davis, Nurse Educator, Diabetes, c/- Cairns Diabetes Centre Other relevant programmes and resources: Living Strong (previously the Healthy Weight Program) Food Cent$ Booklets What to Eat and What is Diabetes? For training in Growing Strong, Living Strong and Food Cent$, and resources, contact the Tropical Population Health Service. Search the Queensland Health internet site. Acknowledgements Cairns Diabetes Centre staff Bronwyn Davis, Credentialled Diabetes Educator Cilla Preece, Innovation Project Officer Alison Kempe, Dietitian Helen Fox, Dietitian Georgina Tabuai, Indigenous Health Worker Julie Haysom, Artist, Cairns Diabetes in Pregnancy Innovation Project team, Department of Endocrinology, Royal Brisbane & Women s Hospital, Brisbane. Lisa Smith, Diabetes Educator, Mackay Population Health Services Growing Strong working group Wuchopperen Health Service, Cairns All staff from the Cape communities, Cairns and Hinterland and visiting services who gave feedback on earlier drafts of the resources. CPIC Innovation Project: Diabetes in Pregnancy