Illness management for people on insulin Pump Therapy

Insulin pump

People with type 1 diabetes usually have an insulin pump, which not only helps improve their blood glucose control but also improves quality of life. However, insulin pump may not be suitable for every one with type 1 diabetes. Some people with type 2 diabetes also have an insulin pump. Please see below information on how to manage blood glucose levels if you are unwell and have an insulin pump.

Information provided may not always be applicable to you. You should always consult your diabetologist or diabetes specialist nurse if you are unwell or making any changes to insulin dose.

What happens to blood glucose when you are unwell?

Hyperglycaemia or high blood glucose may be seen when you are unwell. You may notice high blood glucose even though you have not had anything to eat or drink.

When you are ill your body produces stress hormones which increases insulin resistance. The amount of insulin delivered by insulin pump or insulin injected may not be sufficient. As insulin is not adequate your body switches from carbohydrate metabolism to fat metabolism. This results in development of Diabetic Keto Acidosis (DKA).

It is always good to set alarms in your pump to indicate when your blood glucose is too low or high, so that you can act promptly.

What happens during Diabetic Ketoacidosis (DKA)?

Diabetic Keto Acidosis (DKA) is a life-threatening condition. DKA usually occurs when there is inadequate insulin in the body.  During any stress our body needs more energy and insulin requirement is increased.

When insulin is insufficient glucose cannot be metabolised to provide energy. So, the body breaks down fat to provide alternate form of energy. When fat is broken down, ketoacids are produced. Some of the ketones include acetic acid, acetoacetic acid and beta hydroxy butyric acid. Ketoacids can be detected in the blood and urine.

When the levels of ketones in the body increases leading to Diabetic ketoacidosis(DKA), you may experience nausea and vomiting, abdominal pain and shortness of breath.

If DKA is not promptly treated it can lead to serious consequences and as mentioned above is life-threatening.  You need to seek urgent help. Treatment usually involves intravenous fluids and insulin. Once DKA is treated, underlying reasons for onset of DKA should be addressed.

How can you help prevent onset of DKA?

  1. People with type 1 diabetes cannot survive without adequate insulin. So, never stop taking insulin.
  2. Check your blood glucose levels regularly, that is at least four times a day and every two hours if you find your blood glucose levels is elevated.
  3. Correct high blood glucose levels immediately. Use your correction ratio to reduce your glucose level. This is usually 1 unit of insulin to drop blood glucose levels by 2.5 to 3mmol/l). However, if you may have agreed a different correction dose with your diabetologist or diabetes specialist nurse.

Is your Insulin Pump causing problems?

If your blood glucose levels are elevated whilst on an insulin pump and/or you have ketones in blood or urine, you will need to give correction doses of insulin.  If despite giving your correction dose, your blood glucose remains elevated, your insulin pump may not be working well.

The problems with insulin pump can be varied. Problems could be in the cannula, infusion set or in the actual pump itself. Sometimes due to hardened skin (lipohypertrophy) insulin may not be delivered through the cannula into your body.

First ensure that there is no leaks and the infusion set is not disconnected from the cannula.

What should you do if you pump is causing problems?

If your blood glucose and/or ketones levels are high whilst on an insulin pump, you should immediately give yourself a correction dose through the pump.

If you find that the blood glucose levels remain high despite the first bolus from the pump, you should give the second correction dose using an insulin pen and NOT from the pump.

Always have spare insulin pen when you are on an insulin pump. Try and see if changing the pump device, infusion set or insulin reservoir or cannula helps sort the problem. If not seek immediate help and continue using the pen until the problems with the pump is addressed.

How much is my Total Daily Dose (TDD) of insulin?

Total Daily Dose (TDD) is the total amount of insulin you have had in the previous day. TDD includes both background or basal insulin and any bolus doses you have had.

You can always find your total daily dose of insulin in the pump device you are using.

Do not delay seeking help from your diabetes specialist team. If you are not feeling well despite all the appropriate changes you have made, you should contact your diabetologist or diabetes specialist nurse urgently.

General Advice for people on Insulin Pump

Ensure you keep yourself well hydrated. If you have nausea and vomiting and you do not feel like eating, hold of food but keep drinking fluids to keep yourself well hydrated. Having adequate fluids and preventing dehydration is one of the key features in DKA management. In addition to water you can have sugary drink like fruit juice to prevent hypoglycaemia or low blood glucose.

You could try ice creams or soup if possible.

If you continue to run high blood glucose and/or ketones you should immediately seek help from your diabetes consultant or diabetes specialist nurse. It is always important to ascertain the reason for DKA and treat the cause. Sometimes it may be due to infection, in which case you may need antibiotics.

Illness Management Guidance for People on Insulin Pump

Click on the link below to see a flow chart which provides guidance on how to manage illness when you have Type 1 diabetes and are using an insulin pump.

Illness Management Guidance for People on Insulin Pump

To learn more about Type 1 diabetes click here

Dr Chinnadorai Rajeswaran is a consultant Physician specialising in Endocrinology, Diabetes and Obesity. As a private endocrinologist he  has private endocrine, diabetes and weight loss clinics in Harley Street, London, Chennai (India), Claremont Hospital, Sheffield, Nuffield Hospital, Leeds and Simplyweight, Bradford.

He has face to face consultations with people from Barnsley, Rotherham, Chesterfield, Doncaster, Wakefield, Huddersfield, Bradford, Harrogate, Leeds, Sheffield, London and Chennai (India). He also offers video consultations.

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