The aim of diabetes treatment is to keep blood glucose levels as near normal as possible. This, together with a healthy lifestyle, will help keep a child well in the short term and long term, and improve their wellbeing.
The only medication that treats Type 1 diabetes is insulin. Insulin reduces the amount of sugar in the blood.
Insulin can’t be taken by mouth as it is a protein and would be broken down by the digestive juices in the stomach. Therefore it either needs to be injected, or givenvia a pump. Whether to use insulin injections or a pump will be decided by the child and family and their children’s diabetes team. Using a pump doesn’t mean that a child’s diabetes is more severe.
Children who inject their insulin will generally take four or more injections per day (often known as multiple daily injections or MDI). Some may only take insulin twice a day, but this is less common.
Multiple daily injections (MDI)
Most children nowadays will take multiple daily injections from diagnosis. This is because medical research has shown that MDI can control blood glucose levels better than twice-daily injections. Taking more injections can also give greater flexibility in when to eat and how much.
Children taking MDI will need an injection with each meal as well as an injection at bedtime and/or in the morning, so they’ll need to have to have an injection at school at lunchtime. They might need an injection at other times during the school day too, if their blood sugar levels are high.
Two injections a day
Children who take two injections a day usually take them at breakfast and dinner time, and so won’t usually need to inject during the school day. Not many children take insulin this way now, as it doesn't tend to manage diabetes so well.
Injecting at school
Children who need to have an insulin injection at school will need to bring insulin and their injecting equipment into school. In most cases the equipment will be an insulin ‘pen’ device rather than a syringe. There are two types of insulin pen:
- disposable – these come pre-filled and are thrown away when empty
- reusable – these have a replaceable cartridge of insulin.
Using cold insulin can make the injection more painful, so the insulin a child is currently using should be stored at room temperature. Spare insulin, not currently in use, should be stored in the fridge.
After taking it out of the fridge, insulin can be used for up to one month after which it should be disposed of, whether the cartridge is empty or not. The amount of insulin a child needs to keep at school will depend on how much insulin they are prescribed.
Extremes of temperature will destroy insulin, so it shouldn’t be placed in the freezer, in direct sunlight or near a radiator or any heat source.
Some children might want a private area where they can take their injections, and if so this should be provided. Others may be happy to inject in public, and again this should be allowed.
Children might need help with injecting, especially if they’re younger, newly diagnosed or have learning difficulties.
How to inject insulin
Insulin is injected just under the skin, not into a muscle or vein, and the needles used are only a few millimetres long, and very fine. The child’s parent and paediatric diabetes specialist nurse (PDSN) will discuss the help an individual child needs and train staff on how to use the pen injector, but the following is a guide:
How to inject insulin
Insulin is injected just under the skin, not into a muscle or vein, and the needles used are only a few millimetres long, and very fine.
The child’s parent and paediatric diabetes specialist nurse (PDSN) will discuss the help an individual child needs and train staff on how to use the pen injector, but the following is a guide:
- Do an 'air shot' by turning the button at the end of the pen to two units. Hold the pen upright, and press the plunger firmly. Repeat until you see a drop of insulin at the end of the needle.
- Set the dose by turning the button at the end of the pen until you reach the required dose (as it turns, the button clicks).
- Choose an area with plenty of fatty tissue, eg the stomach, legs or bottom.
- Lift up a fold of skin.
- Push the needle in quickly.
- Press the plunger down fully.
- Keep the needle in place and the skin fold lifted for a count of 10.
- Remove the needle each time.
Most children will have injections in their stomach, legs and bottom. Sites used for injection should be rotated, to prevent fatty lumps forming.
An insulin pump delivers a small, varying amount of insulin around the clock, which is pre-set according to the individual child’s needs by the parent or PDSN. This reaches the tissues just under the skin via a tiny tube called a cannula. This cannula sits in the same areas that you would give an insulin injection – the stomach, legs or bottom.
Most pumps are connected to the cannula by a thin, flexible tube, but there are also pumps which sit directly on the skin. The cannula can usually stay in place for two to three days so shouldn’t need changing at school unless it becomes dislodged or blocked.
An insulin pump needs to stay attached to the child and can only be disconnected for short periods. If the pump is disconnected (eg for PE or swimming), the cannula stays in place and a cap is placed on the exposed end.
Insulin pumps run on batteries and have many safety features, including warning alarms if the battery runs low or the pump is running out of insulin.
Insulin pumps at school
As well as the background dose of insulin that is continuously delivered by the pump, children who use an insulin pump will need to give extra insulin via the pump when they eat or if their blood glucose levels are high. This is done by pressing a combination of buttons. Again, children might need help with this. Their parent/carer and PDSN will train school staff on how to give insulin via the pump and how to look after the pump at school.