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Adjusting Insulin During Illness (Insulin Pump)

For those on Injected Insulin, instead see:
Adjusting Insulin During Illness (Injections)

Managing your child’s diabetes when he is sick is challenging. In addition to the 10 Safety Rules for Managing Diabetes When Your Child is Ill, here are specific tips for insulin pump users:

  • If blood glucose is less than 14.0 mmol/L or the ketones are negative: the usual correction may be used, and may be delivered through the pump.
  • If blood glucose is 14.0 mmol/L or higherAND blood ketones are 0.6 mmol/L or higher (or urine ketones are positive):
    • it is wise to give your child a correction by injection (pen or syringe) right away.

When ketones are positive, your child may need at least 50% more correction insulin than normal. You can use one of the following methods to calculate the approximate amount of extra insulin:
(Both methods yield the same result – “A” uses the pump bolus calculator; “B” is calculated from scratch.)

A.  Give a correction that is 50% more than what your bolus calculator recommends.
For example, if it recommends 6.4 units, give 3.2 units more, for a total of 9.6 units. Round off and give 10 units by injection.

B.  Use a correction formula to calculate the dose:

(current blood glucose) – (target blood glucose)   X  1.5
Insulin sensitivity factor

For example, if the blood glucose is 22.8, ketones are ++, insulin sensitivity factor is 3, and the target blood glucose is 7…

(22.8 – 7)  X  1.5  = 7.9
3

Round off and give 8 units by injection.

  • After giving the insulin by injection, it may be wise to change the infusion set. Keep correcting high blood glucose every 2 – 3 hours.
  • If your child has an illness that results in ongoing high blood glucose, you may choose to increase the basal rate. It may be helpful to set a temporary basal rate of 20-50% more for 4 hours, then reassess.
    • If the blood glucose is still high, you may want to increase the basal rate by another 20-50% for 4 hours.
    • Always reassess the basal rate every 4 hours.
  • If your child’s illness has resulted in low blood glucose (less than 4.0 mmol/L): treat the low, consider stopping the pump for 1 hour, then reassess.
    • When the blood glucose is 6.0 mmol/L or more, you may restart the pump with a decreased basal rate. Setting a temporary basal rate of 50% less for 4 hours and then reassessing may be helpful.
    • You may choose not to bolus for foods or fluids until the blood glucose is 10.0 mmol/L or more.

References:

The above information was adapted with permission from The Alberta Children’s Hospital Diabetes Clinic information handouts.

The above information was reviewed for content accuracy by clinical staff of the Alberta Children’s Hospital Diabetes Clinic.

This material has been developed from sources that we believe are accurate, however, as the field of medicine (in particular as it applies to diabetes) is rapidly evolving, the information should not be relied upon, as it is designed for informational purposes only. It should not be used in place of medical advice, instruction and/or treatment. If you have specific questions, please consult your doctor or appropriate health care professional.

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