Diabetes Nurse

About This App

Written on 08/30/2018
Nemanja Stojanovic

Diabetes Nurse

 

It is our wish that every person with diabetes has access to the advice that wold be supplied by a diabetes nurse. We hope that nurses, doctors, healthcare providers, pharmacists, health care professionals and diabetes nurses will find this app to be helpful, if only to show it to patients!

We have included in this app instructions for use of all the commonly used devices in the treatment of diabetes.

 

Diabetes Nurse has several sections:

 

  • Insulin Starter Pack
  • Insulin Pens (with subsections): Disposable Devices/ Durable Pens/ Half Dial
  • Diabetes General Information
  • Hypoglycaemia/ Sick Day Rules
  • Disability/ Needle Phobia Devices
  • Insulin Fact Sheet
  • GLP-1 Injection Devices
  • About This App
  • Contact Us

 

The sections in greater detail:

 

Insulin Starter Pack

 

  • Information for a Patient Starting Insulin covers in six minutes topics that must be discussed with someone starting treatment. It acts as an introduction to insulin therapy, and briefly covers what the patient needs to know about glucose and ketone testing, hypoglycaemia, sharps disposal, driving, and sick day rules. All of these topics are covered in depth in separate videos, but rather then overwhelming a patient with information, this is meant as a crash course.

 

  • The Newly Diagnosed Diabetes video deals with general information that should be given to a person who has just been diagnosed with diabetes: potential complications and how to prevent them, driving, blood pressure and cholesterol, exercise, and the difference between Type 1 and Type 2 Diabetes.

 

  • The Injecting Insulin video explains how to inject insulin, skin preparation, insulin storage etc.

 

  • The Testing Blood Glucose video explains the correct technique for testing blood; which part of the fingertip to use, how to maintain the equipment, etc.

 

  • The Sharps Disposal video discusses methods for sharps disposal. Sharps MUST be disposed of safely. Careless sharps disposal may lead to needlestick injury, which may result in disease transmission, such as HIV, Hepatitis B and C etc.

 

The Insulin Pens section has three subsections:

 

The Disposable Devices subsection discusses the use of single use pens and insulin syringes.

 

  • SoloStar Pen: single use device used for injecting Insulin Glargine (Lantus), Insulin Glulisine (Apidra) - both analogues, and some of Sanofi’s human insulins, Insuman Basal and Insuman Comb 25.

 

  • FlexPen: for injecting Novorapid (Novolog), Levemir (Detemir) and NovoMix 30 Insulins.

 

  • KwikPen: a disposable (single use pen) for injecting Humalog, Humalog Mixes 25 and 50, Humulin I  and Humulin M3.

 

  • FlexTouch Pen: for injecting Novorapid (Novolog) and Insulin Degludec (Tressiba). Insulin  Degludec comes in concentrations of 100 and 200 units and this is explained in “The New Insulins and Devices 2015 “ video, located in the Diabetes General Information section. Use of the Flextouch pen for injecting IDegLira, a combination of Insulin Degludec and Liraglutide Victoza  (the medication is marketed as Xyltophy), is described in the GLP-1 Analogues section.

 

  • Innolet Device: used for injecting long acting insulins, Levemir (Detemir) and Insulatard.

 

  • The Insulin Syringe video discusses the use of an insulin syringe and how to mix long and short acting insulins in the syringe.

 

  • Insulin Toujeo: The use of Insulin Toujeo (concentrated Insulin Glargine) is discussed in this video. The use of both the pen and the insulin is slightly but significantly different and this video should be seen before changing the patient to Toujeo from another long acting insulin.

 

  • The new addition to the Eli Lilly’s insulin portfolio, Humalog 200, is discussed in the last video of the section.

 

Durable (Cartridge) Pens. This section discusses the use of durable devices where insulin is supplied in a cartridge. The cartridges are replaced once empty and the pen is then reused.

 

  • Humapen Savvio: a durable (reusable pen) which uses 3ml cartridges. Insulins available in the cartridges are Humalog, Humalog Mixes 25 and 50, Humulin S, Humulin I, Humulin M3 and Insulin Abasaglar (Eli Lilly’s version of long acting Insulin Glargine).

 

  • NovoPen 5: NovoNordisk’s current reusable (durable) pen is NovoPen 5. The half dial version of this pen is Novopen ECHO (meaning the the Novopen ECHO can dial as little as half a unit of insulin).  The insulins available, supplied in 3ml cartridges, are: NovoRapid (NovoLog), NovoMix 30, Levemir and Degludec (Tresiba) in concentration of100 Units/ml.

 

  • ClickStar is Sanofi Aventis’ durable (reusable) pen that uses 3ml penfill cartridges. The following  insulins are available to be used with this pen: Insulin Glargine (Lantus),  Apidra (Glulisine). Human insulins available are Insuman Comb 15, Insuman Comb 25, Insuman Comb 50, Insuman Basal and Insuman Rapid. Insulin Toujeo, which is Insulin Glargine in concentration 300U/ ml is NOT available in cartridges.

 

  • Autopen 24 is a pen produced by a British manufacturer, Owen Mumford, for Sanofi Aventis’ insulins: Insulin Glargine (Lantus),  Apidra (Glulisine). Human insulins available are Insuman Comb 15, Insuman Comb 25, Insuman Comb 50, Insuman Basal and Insuman Rapid. Insulin Toujeo, which is Insulin Glargine in concentration 300U/ ml is, once again, NOT available in cartridges. This pen precedes Sanofi’s own device, ClickStar, and also has attachments that can facilitate injecting insulin for people who are affected by a disability.

 

 

 

 

 

Diabetes General Information

 

 

  • The “Insulin: Classification, Types, Treatment Regimens” video explains the differences between various insulins (cloudy vs clear, short vs long acting, insulin mixes, human vs analogues), and how are these administered in different regimens.

 

  • The “New Insulins and Devices” video goes through the recent developments in the insulin market: Insulin Degludec (Tresiba), Insulin Abasaglar, Insulin Toujeo, and Humalog 200 are referenced here.  IDegLira (Xultophy) is mentioned, but there is a separate video explaining the use of this medication in the GLP-1 section.

 

  • “HbA1c: Measure of Diabetes Control” discusses HbA1c, the three-monthly measurement of diabetes control: how is HbA1c formed, what it should be, and the difference between DCCT and IFC measurements.

 

  • BD Autoshield Duo is an insulin needle that prevents any injury to a carer injecting a patient with insulin (a nurse, relative etc).  The use of BD Autoshield Duo is discussed here.

 

 

 

Half Dial Pens

 

Discusses the use of two devices that can dial as little as half an unit of insulin (thus the name “half dial pens”)

 

  • NovoPen 5: NovoNordisk’s current reusable (durable) pen is NovoPen 5. The half dial version of this pen is Novopen ECHO. Insulins available, supplied in 3ml cartridges, are: NovoRapid (NovoLog), NovoMix 30, Levemir and Degludec (Tresiba) in concentration of 100 Units/ ml.

 

 

  • Humapen Luxura  HD (and Humapen Luxura) - HD stands for half dial.  Humapen Luxura is no longer produced but there are still quite a few of these devices in use and some are still on sale on the internet. As a result, the use of both Humapen Luxura and Humapen Luxura HD (which is identical) is discussed in the same video. Cartridges and insulins available for Humapen Savvio are identical to those for Humapen Luxura HD.

 

 

 

 

 

 

 

 

 

Hypoglycaemia/ Sick Day Rules

 

This section has three videos:

 

  • “Sick Day Rules” gives advice as to what to do when unwell. General rules about the use of metformin and insulin during acute illness, ketone testing, food intake and supplements, etc. are discussed here.

 

  • The “Hypoglycaemia - Low Blood Sugar” video gives advice on how to treat low blood sugar which is a dangerous complication of insulin treatment. Glucagon administration, used in unconscious patients with hypoglycaemia is discussed in a separate video.

 

  • “Glucagon: Emergency Treatment for Hypoglycaemia” is a video that explains how to mix and administer glucagon, an injection that is used in patients with diabetes whose sugar is so low that they are unconscious and therefore unable to eat and drink. The person who is unconscious due to low blood sugar may also be having an epileptic fit, so this video should be seen by a potential carer well before any eventual emergency!

 

 

 

 

 

 

Disability/ Needle Phobia Devices

 

 

This section starts with a video about NovoNordisk’s device for people with needlephobia (a fear of needles) - the Novofine Autocover devices. A phobia of needles requires help from a psychologist, but quite a few people find these devices helpful. This device can only be used with NovoNordisk’s devices: FlexPen, FlexTouch Pen, Innolet Device, NovoPen Echo, NovoPens 5, 4 and 3.

 

The other devices discussed in this section are the Flextouch and Innolet devices (these videos are identical to those in the Disposable Pens/Insulin Syringe Sections) as these devices may be easier to use in patients with a disability affecting the use of hands, such as arthritis or the aftermath of a stroke.

 

 

 

 

Insulin Fact Sheet

 

 

For each manufacturer, a list with long acting insulins is given first, followed by short acting insulins, and insulin mixes are given at the end.

 

Eli Lilly

-  Long Acting Insulins Humulin I and Glargine (Insulin Abasaglar)

  • Short Acting Insulins: Humalog (generic name Lispro), Humulin S
  • Insulin Mixes: Humulin M3, Humalog Mix 25, Humalog Mix 50

 

NovoNordisk

  • Long Acting Insulins: Insulatard, Levemir (Detemir), Tresiba (Insulin Degludec)
  • Short Acting Insulins: Actrapid, NovoRapid (NovoLog) - its generic name is Insulin Aspart
  • Insulin Mixes: NovoMix 30

 

Sanofi Aventis

  • Long Acting Insulins: Insulin Glargine (Lantus), Insuman Basal, Insulin Toujeo (Glargine in concentration 300 U/ml)
  • Short Acting Insulins: Insuman Rapid, Apidra (Insulin Glulisine)
  • Insulin Mixes: Insuman Comb 15, Insuman Comb 25, Insuman Comb 50

 

 

 

 

GLP-1 Injection Devices

 

Each of the GLP-1 Analogues available on the market has a different dose and injection device. Some of the medications in this class are injected daily and some are given weekly (see the video “GLP-1 Analogues General Data and Comparison”). In this section we explain how to use:

 

  • BYDUREON Pen - this medication is given once weekly. This is a longer lasting preparation of exenatide. In some countries BYDUREON is still supplied in its injection kit. The use of the kit is explained in a separate video in this section.
  • Victoza (Liraglotide) Pen - this medication is given once daily. Doses are explained in the video.
  • Trulicity (Dulaglutide) Pen - this medication is given once weekly.
  • Exenatide (Byetta) Pen - this medication is given twice daily. Doses are explained in the video.
  • Trulicity (Dulaglutide) Pen - this medication is given once weekly.
  • BYDUREON injection kit - this medication is given once weekly. The same long acting preparation of exenatide is discussed in the first video of this section. The kit is still use in some countries, but is no longer available in the UK and the US.
  • Lixisenaide (Lyxumia) - this medication is given once daily. Doses are explained in the video.
  • IDegLira (Xultophy) - a combination of GLP-1 Analogue Victoza and Insulin Degludec which is given as a once daily injection. The device used is the Flextouch pen. Starting doses, titration, and maximum dose are all discussed in this video.

 

The last part of this section has two videos:

 

  • “GLP-1 Analogues: General Data and Comparison”. GLP-1 Analogues available on the market are discussed in this video. Topics covered are classification, the effects on glucose, help with weight loss and HbA1c, the side effects of this class, warnings and cautions, and a head-to-head comparison between the medications in this class.
  • “GLP-1 Analogues: Mechanism of Action”. For the curious among you, this video explains how these medications work.

 

More is coming soon!