Hyperglycaemia (BGL 15mmol/L or higher)

Assessment and management of high BGLS, ketones and potential line failure 

Some common causes of hyperglycaemia are:

• Pump setting need adjusting to give more insulin.
• Missed meal bolus (you can check when last bolus was given in the status screen or pump history)      
• Illness, stress or hormonal changes
• The delivery of insulin is interrupted or suspended
• The insertion site is not absorbing insulin, line has fallen out or not connected to the pump

Line Failure = Cannula has bent underneath the skin – this means your body is not receiving insulin and requires immediate management

BGL 15mmol/L or higher, check the following: 

• blood ketones
• the last meal bolus was given
• the line is not kinked 
• no air in the tubing 
• dressing for leaking insulin (you might smell it) 
• site check for signs of infection – red or tender. If signs of infection go to your GP to have the site assessed
• insulin in the reservoir

Tandem T Slim = 

Medtronic = Status menu, number of units is indicated next to “Pump”

Hyperglycaemia (BGL 15 mmol/L or higher) & Ketones less than 0.6 mmol/L

After confirming the ketones are <0.6mmol/L:

1) Enter BGL into your pump and get a correction dose

2) Avoid eating carbohydrate until you are sure you are receiving insulin.  (You will know that you are getting insulin because your BGL will lower)

3) Re check BGL in 2 hours

4) In 2 hours, if your BGL is:

• Lower - your line is working.

Continue to monitor BGLs until your BGL is in target range

• Unchanged or higher –you are probably not getting insulin
  • Check ketones.
    • If 0.6mmol/L or higher see positive ketones (next page)
    • If less than 0.6 mmol/L -Complete a full line and cannula change, correct BGL using new line (enter BGL in pump) and check BGL and ketones in 2 hours

Hyperglycaemia (BGL 15mmol/L or higher) & Ketones 0.6 or higher = Positive ketones

High blood glucose + ketones = Not enough insulin in the body

• Insulin pump therapy carries a higher risk for developing ketones than injected insulin because it only uses short acting insulin
• Insulin pump users need to have access to fast acting injected insulin at all times e.g. NovoRapid Flexpen® or Humalog Kwikpen®
• A ketone reading of 0.6mmol/L or higher is positive and if associated with BGL >15.0mmol/L needs immediate treatment with “urgent dose” injected insulin (see below), given by pen or syringe, not the pump.

Step 1:

Calculate “urgent dose” by dividing your pump total daily dose (PTDD) of insulin by 6

• Give injected “urgent dose” insulin. Do not use the pump to correct the high BGL
• Disconnect the pump
• Enter the BGL in the pump, change the recommended bolus to the urgent dose just injected and deliver the insulin correction into the air. This will keep a record of the BGL and active insulin in the pump.
• Complete a full insulin reservoir, line and cannula change and reconnect your pump
  

Step 2:

• Re-check BGL and ketones in 2 hours
• If ketones are 0.6mmol/L or higher and BGL is 15.0 or higher, repeat step 1, however a line change is not required. Contact RCH sick day service if you require assistance – 03 9345 5522
• If ketones are 0.6mmol/L or higher but BGL is less than 15.0mmol/L, use your pump to bolus for both the BGL and any CHO consumed.
• If ketone are less than 0.6mmol/L, use your pump to bolus for both the BGL and any CHO consumed.
• Continue to re-check BGL & ketones 2 hourly until the BGL is less than 15mmol/L and ketones are less than 0.6mmol/L

NOTE:  Urgent dose will change as PTDD changes. Update this dose regularly

PTDD is accessed in your pump history or from your download report  

Medtronic – HISTORY – SUMMARY – 7 DAYS

Tandem: T SLIM: OPTIONS – PUMP HISTORY – DELIVERY SUMMARY – 7 DAY AVERAGE