Sick day management for insulin pumps

  • The following advice relates to days when you are unwell

    Insulin may be reduced, but NEVER stop insulin

    Seek medical advice early if you are unsure of what to do

    DKA pump

    BEWARE vomiting + BGL 15mmol/L or higher + ketones needing treatment (0.6 mmol/L or higher) – this usually indicates line failure and potential Diabetes Ketoacidosis (DKA)

    This requires injected insulin, a full line change and very close monitoring 

    Seek immediate medical advice if:  RCH Sick day service 9345 5522 and ask for the “Diabetes sick day service”

    • You are unsure about insulin pump management during illness
    • Vomiting for than 2 hours
    • Severe stomach pains or rapid breading
    • Persistent Hypoglycaemia
    • Drowsy or lethargic or changes in conscious state
    • BGL or ketones continue to rise despite extra insulin
    • Blood ketones are 0.6 mmol/L or higher and you are unsure how to manage this 

    Blood glucose strips, ketone strips, glucagon and spare insulin are all required during session 

    If persistent vomiting or persistent ketones of 0.6 mmol/L or higher and high blood glucose Contact RCH sick day service

    Check blood ketones every 4 hours regardless of BGL value

    Check BGLs hourly if less than 5 mmol/L and unwell, otherwise 2 hourly checks

    • Seek medical advice from your GP in relation to the illness if required
    • When unwell, Sensor glucose may be less accurate, particularly if you are dehydrated. Frequent BGLs must be done, and if different to SG, rely on BGL 

      BGLs often rise during illness and insulin requirements often increase:  

    • An insulin injection via pen as well as a line change is required if the glucose is 15 mmol/L or more and ketones 0.6 mmol/L or higher. Follow line failure management
    • A temporary basal rate (TBR) is required if glucose readings remain outside target range. Increase the TBR if glucose is high and decrease TBR if glucose is low. Initially adjust by 20-30% (Keep in mind changes to TBRs take a couple of hours to have an effect)
    • Correction bolus doses will be delivered as BGLs are entered into the pump. Remember BGLs must be entered to get corrections.
    • Maintain hydration with frequent sips of water or electrolyte containing fluids
    • E.g. Hydrolyte® fluid, Gastrolyte® ice blocks (there is limited CHO in these products)
    • When the BGL is less than 10.0mmol/L or appetite is decreased, consider sugar containing fluids. E.g. diluted juice, sports drinks/soft drinks/lemonade icy poles
    • Bolus for carbohydrate eaten
    • For illness associated with hypoglycaemia consider a 50% reduction of the recommended food bolus amount (only do this if no ketones present; if ketones present and hypoglycaemia, treat the hypo and see next page
    • Food boluses may be given 5-10 minutes after eating if you are nauseated and unsure if you will keep the food down but do not skip insulin completely as this may cause ketones to develop / increase.

    Mini-dose Glucagon may be required with persistent hypoglycaemia

    Managing ketones of 0.6 mmol/L or higher for insulin pump therapy:

    ketone management CSII