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Insulin Pump Therapy: Troubleshooting when Blood Glucose is High

1. If your blood glucose is rising and not coming down after a correction bolus take the infusion set out and check to see if it was bent or kinked.  Do NOT continue to give correction boluses via the pump.  Always check your blood glucose 1-2 hours after changing your set.

2. If sugars are above 250 and have been for a few hours, check urine for ketones:

  • If ketones are small: give a correction dose by injection.
  • If ketones are moderate or large: double the calculated correction dose or take 20% of your daily dose of insulin (check your history for the last several days to get an average daily dose).  Administer it by injection – NOT via the pump.
  • Drink at least 8-16 ounces of water or sugar-free/caffeine-free fluids every hour to  stay well hydrated

3. Insert a new infusion set.

4. Continue to monitor your blood glucose and ketones until you are under 200 and your ketones are negative to trace.

5. If sugars are not coming down, ketones are remaining, or you're not feeling feeling well, call the Diabetes Center of Excellence clinic at (508) 334-3206 or the on-call fellow after hours at (508) 334-1000.

Have a source of fast-acting glucose available to use if the correction dose makes you go too low.  Follow usual guidelines for treatment of lows.

Be prepared and have the following available:

  • Vials or pens of insulin (both long acting and rapid acting)
  • Dose of long acting insulin to take in case of pump failure
  • Syringes or pen needles
  • Ketone strips
  • Glucagon
  • Blood glucose test strips
  • Fast-acting glucose such as glucose tablets, juice, glucose gel, etc.
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