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 it can be used for energy. The pancreas is a very complex organ that constantly adjusts insulin levels, minute to minute, to keep the blood glucose in a healthy range.
The amount of glucose in the body at a specific point in time is called “blood sugar” or “blood glucose” (abbreviated as BG) level. This graph shows how blood glucose fluctuates normally, in a person without diabetes:
Without insulin, glucose builds up in the blood, causing tiredness, thirst, frequent urination, and weight loss. These are some of the symptoms of untreated type 1 diabetes.
People 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 or an insulin pump are effective, but neither can respond the same way a pancreas can.
The ideal situation is to give insulin before every meal, varying the amount according to how much a person is planning to eat and how high their blood sugar is. So for example, if they are eating a small amount of food, the insulin dose will be small. If they are eating a big meal, they will need more insulin. The formula to determine the insulin dose is specific to each person.
This kind of intensive management results in better overall diabetes control and helps to prevent or delay long-term complications of diabetes. For children and youth in school, it means they would need insulin at lunch every day, and this isn’t always an option.
Another way to manage diabetes is to give a slower-acting insulin at breakfast, which will be active around lunchtime and in the afternoon. This is less precise dosing but is the best alternative if giving insulin at lunch is not an option. Students on this regimen will take insulin 2 to 3 times a day: breakfast, dinner (suppertime), and usually at bedtime.
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.
Insulin is delivered in one of three ways:
The amount of insulin a person needs depends on how much food they eat, their activity levels, their age and size, and other factors. Insulin doses may vary from day to day.
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 will be trained on how to determine the dose as well as how to give it. Here are the basic steps:
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.
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.
Injecting insulin with a pen (Source: BD)
Using an insulin pump: Training is specific to the make and model of the pump. Here are some videos and other resources on delivering a bolus dose of insulin from the major pump manufacturers (alphabetical order):
Last updated: April, 2018