Test urine for ketones:
- Each morning
- When blood sugar is greater than 240
- Test even at night
- Troubleshoot the pump
- check the last bolus
- check the basal rates
- check the battery
- If ketones are positive follow the DKA Prevention Tree
Change your infusion site:
- Every 48 hours
- Rotate, at least 1/2 inches from the last site
- Stay 2 inches away from scars or navel
- Preferably not before bed
- When site is reddened, swollen, painful or drainage, or if blood is at the site or in the tubing
- If ketones are present without explanation
- If you have more than 2 readings over 240 even after taking correction boluses in a row that you can't explain.
Check blood sugar:
- Prior to meals and bedtime snack
- 2–4 hours after changing an infusion site
- Midnight and 3 a.m. for the first week, then weekly midnight and 3 a.m.
- Occasional 2-hour post-prandial (after a meal) as requested by the diabetes team
- If blood sugar is under 70 at night: retest the following night after adjustments have been made.
When disconnecting:
- After one hour off the pump check your blood sugar.
- Do not disconnect for more than 2 hours.
- When you reconnect, test your blood sugar:
- If you are above 140 take your missed amount of basal insulin as a bolus
- If greater than 240 test for ketones, follow decision tree guidelines
- Leave your pump in run mode, do not suspend or stop.
- If you are disconnecting for a sport or exercise; you need to connect halfway through to take your missed amount of insulin if the total disconnect time is greater than 2 hours.
Treating low blood sugars:
- Low blood sugars can happen on a pump if:
- Basal or bolus amounts are too high
- Coverage scale is too high
- Exercise or post-exercise hypoglycemia
- Alcohol consumption
- Do not bolus for the first 15 grams of carbohydrate
Consumed (4 oz. of juice or 3 glucose tablets)
- You may not need an additional snack unless exercising
- If you eat a snack, you may need to bolus to cover the extra carbohydrate consumed if not exercising.
Always carry:
- Treatment for low blood sugar
- An alternative source of insulin (insulin pen or bottle and syringe)
- Meter for blood glucose testing
- Urine strips for ketone testing
- An extra set of tubing, cartridge and insulin
- Glucagon emergency kit
- Medical identification for diabetes
Sick day management:
- Do NOT disconnect your pump.
- Test for ketones every four hours and when above 240.
- Call for help if:
- Ketones are positive
- Nauseated, vomiting or unable to eat
- Temporary basal may need to be established based on blood sugar and ketone level.
- Drink 8 oz. of fluids each hour, sugar or sugar–free will depend on the food intake and blood sugar levels.
