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Insulin pump line failure

  • Insulin pump line failure: BGL of 15 mmol/L or higher with ketones of 0.6 mmol/L or higher 

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

    • Insulin pump therapy carries a higher risk for developing ketones compared to other insulin regimens because only rapid acting insulin only is used
    • Insulin pump users need to have access to rapid acting injected insulin at all times as an alternative way of giving insulin e.g. NovoRapid™ Flexpen or Humalog™ Kwikpen.
    • A ketone reading of >0.6mmol/L is positive and if associated with BGL >15.0mmol/L needs immediate treatment with “urgent dose” injected insulin (see below) via pen or syringe

      Step 1

    • Calculate “urgent dose” by dividing your pump total daily dose (PTDD) of insulin by 6
      • Give “urgent dose” of Novorapid ™/Humalog ™ via pen or syringe

     Do not use the pump to correct the high BGL

    • Disconnect the pump from your body
    • 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 the injected insulin in the pump. Your injected insulin will be calculated in your pump active insulin

    • Complete a full insulin reservoir, line and cannula change and reconnect your pump

    It is ok for basal insulin to be running at this time

    Note

    Urgent dose will change as PTDD changes. Please update this dose regularly.

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

    • MEDTRONIC – HISTORY – SUMMARY – 7 DAYS
    • T SLIM: OPTIONS – PUMP HISTORY – DELIVERY SUMMARY – 7 DAY AVERAGE

    Step 2

    • Re-check BGL and ketones in 2 hours
    • If ketones are > 0.6 mmol/L and BGL > 15 mmol/L, repeat step 1 (including inject pen insulin), however a line change is not required. Unless you are confident with appropriate action, seek urgent medical advice. Continue close monitoring
    • If ketones are > 0.6 mmol/L and BGl < 15 mmol/L, enter your BGL and any CHO consumed into the pump and give the calculated bolus. Continue close monitoring and seek medical attention if any concerns
    • If ketones are <0.6 mmol/L, Bolus as usual

    Continue to re-check BGL & Ketones 2 hourly until BGL <15 mmol/L and ketones < 0.6 mmol/L.

    For RCH patients, 24/7 sick day support is available. Call the RCH switchboard 9345 5522 and ask for the “diabetes sick day service”.

    You will not know your new line is working until the effect of your injected insulin has finished. Be aware – Every line change carries the risk of line failure.

    If your BGL and ketones remain elevated, assume line failure and give injected insulin.

    If the Ketones are >3.0mmol/L and/or your child has been vomiting for two hours, it is recommended that you present to hospital for urgent medical assessment.