Insulin: What school staff need to know

Insulin is a hormone, produced by the pancreas, that controls the level of glucose in the blood. Insulin helps the glucose get into the cells so that it can be used for energy. The pancreas is a very complex organ that constantly adjusts insulin levels, minute to minute, to keep blood glucose in a healthy range.

The amount of glucose in the body at a specific point in time is called a “blood sugar” or “blood glucose” (abbreviated as BG) level. This graph shows how blood glucose fluctuates normally, in a person without diabetes:

Insulin and type 1 diabetes

People living with type 1 diabetes do not produce any insulin, so it must be replaced. It is very difficult to do what the pancreas does (in the graph above), adjusting to food intake, activity levels, stress, and other factors. Insulin injections and insulin pumps are effective, but neither can respond the same way a pancreas can.

Students with diabetes need insulin before every meal or snack, and the amount of insulin depends on how much carbohydrate is in the food and their blood sugar level at the time. For example, if they are eating only a few carbohydrates, the insulin dose will be small. If they are eating a bigger meal with more carbohydrates, they will need more insulin. The formula to determine the insulin dose is specific to each person.

When younger children or other students unable to administer their own insulin cannot receive consistent adult support for lunch and snacks, a slower-acting insulin may be given at breakfast and will be active around lunch and in the afternoon. This is not the standard of care and should be the option of last resort.

How children receive their insulin is an individual decision that parents make with their child’s health professional. Details will be in a student’s Individual Care Plan.

How insulin is delivered

Insulin is only given by injections under the skin (in an arm, thigh, buttocks, or stomach). It cannot be taken by the mouth.

At school, insulin is delivered in one of two ways:

• An insulin pen: uses a cartridge of insulin and a dial that allows the user to select the dose. There is a fine needle at the tip of the pen. It is injected under the skin—in an arm, thigh, buttocks or stomach.
• An insulin pump: is a device that administers insulin continuously through a small tube inserted under the skin. The user directs the pump to give a bolus (dose) of extra insulin with meals/snacks or to correct high blood sugar levels. A pump is not an artificial pancreas: Although some pumps can auto-adjust insulin delivery when connected to a continuous glucose monitor, they all require the user to determine when and how much insulin to give for meals.

How insulin is stored

• Unopened vials or cartridges of insulin are refrigerated until they are ready to use. Be sure that insulin does not freeze.
• Once opened, most vials and cartridges can be left at room temperature for no more than 30 days.
• Always check expiration dates before using. Do not use insulin that has expired.

How much insulin to give

If a student needs insulin during the school day, details will be in their Individual Care Plan. School staff who are designated to administer or help with insulin administration will be trained on how to determine the dose as well as how to give it. Here are the basic steps:

Insulin via a pump

1. Check blood sugar (BG) before the student eats. The reading will:
   • Be sent to the pump automatically by the meter or continuous glucose monitor, or
   • Need to be manually entered into the pump.
2. Enter the total number of carbohydrates to be eaten (as labeled by parent or the student)
3. The pump will calculate the amount of insulin to be given. Press the appropriate button to accept and deliver the bolus (dose).

Insulin via injection (pen)

Refer to the student’s Individual Care Plan for details. In general, parents will send food that is clearly labeled with the amount of carbohydrates, and an appropriate tool to help designated staff select the appropriate dose based on the student’s BG. A second adult should double-check the dose before delivering it.

After insulin is given at school, the dose and time should be recorded in the student’s log book or other home−school communication method.

Additional resources

• Video - Insulin: What School Staff Need To Know
• A Guide to Insulin Pumps at School
• Bolus insulin calculator for school lunches: To access this handy tool developed by B.C. Children's Hospital, click on "Basal-Bolus Insulin with MDI", then choose from among a number of links that will automatically calculate insulin dose for specific situations.
• Continuous glucose monitoring