Problem Solving High Blood Sugars When Using an Insulin Pump
Any type of illness can raise your blood sugar because of the stress hormones that are produced. Therefore, your blood sugar level may be high even when you are not able to eat. Blood sugar levels may also become hard to control. If blood sugar levels get high enough, it can lead to a life-threatening condition called diabetic ketoacidosis (DKA).
Diabetic Ketoacidosis or DKA
DKA is caused by not having enough insulin in the body. When you do not have enough insulin, the body burns fat for energy. This breakdown of fat produces ketones (an acid). DKA can occur when high levels of ketones build up in the blood. When you are sick, it can develop within a few hours or overnight. If not treated, it can lead to coma and death.
Insulin used in a pump often wears off in 3 - 4 hours. If a problem occurs with your infusion set or your pump, DKA can develop within hours. You must be aware of the causes and warning signs of DKA. You will need to check your blood sugars every 2 to 3 hours when you are sick. You should have urine ketone testing strips available at all times. You may also need to inject insulin with a syringe to treat high blood sugars until your blood sugars are controlled.
Causes of High Blood Sugars with Insulin Pump Users
- Any illness, infection, surgery.
- Infection at infusion site.
- Infusion set has pulled out or disconnected.
- Physical or emotional stress.
- Insulin exposed to extremes in temperature.
- Some medicines may increase blood sugar levels.
- Old or expired insulin. Once opened, insulin is good for 28 days.
- Infusion set has been in longer than 3 days.
Warning Signs and Symptoms
Symptoms of high blood sugars are early warning signs of DKA. Be careful! Signs and symptoms of DKA are often the same as the flu. If you live alone, you should tell a family member or close friend that you are ill and have them call to check on you several times each day.
Symptoms of High Blood Sugars
- Increased thirst (your body needs extra fluids).
- Increased urination (your body’s way of getting rid of extra sugar).
- Fatigue (your body’s cells are not getting enough sugar or energy because you lack insulin).
- Weight loss (your body is burning fat for energy).
- Dehydration (due to increased urination, vomiting, diarrhea, fever).
Symptoms of DKA
- Nausea or vomiting.
- Abdominal pain.
- Rapid, labored breathing.
- Fruity odor to the breath.
- Severe dehydration.
Steps to Take for High Blood Sugars
- If your blood sugars are over 250 mg/dL, 2 times in a row, and are not coming down with extra insulin, read the Troubleshooting Questions on the next page. These questions may help you figure out the cause of your high blood sugars.
- Check your urine for ketones every time you urinate.
- If ketones are negative, you can bolus insulin using the pump once. Keep testing your blood sugar and ketones every 2 hours. If your blood sugars do not improve after a bolus from the pump, you will need to inject all insulin using a syringe.
- If ketones are positive, use a syringe to take rapid-acting insulin (Humalog®/NovoLog®/Apidra®). This insulin can be taken every 2 hours until the blood sugar is back to your target range and ketones are negative.
- Change your reservoir and infusion set.
- Drink fluids. (see Nutrition Guidelines below)
- Call the UWHC Diabetes Clinic for help. The clinic number is 608.263.7741. If after hours, weekends or holidays, call 608.262.0486 and ask for the diabetes team on-call. The team is available 24 hours a day.
Ask yourself the questions below if your blood sugars are over 250 mg/dL. This may help you to find the cause of high blood sugars and prevent DKA.
- Are you getting a cold or virus?
- Is your stress level higher than usual?
- Are you ovulating or premenstrual?
- Have you gained or lost weight suddenly?
Blood Sugar Control
- Are you having frequent low blood sugars?
- Have you checked your blood sugars during the night? You may be having lows and not waking up.
- Are you having swings of low and high blood sugars?
- What are you using to treat low blood sugars?
- Are you estimating too much or too little insulin to cover high blood sugars?
- Are you estimating too much or too little insulin to cover your carbohydrates?
- Does your correction scale need to be adjusted?
- Has your insulin been exposed to extremes in temperature? If in doubt, use a new vial. Insulin does not work when exposed to extreme temperatures.
- Have you changed your level of activity?
- Are you having low blood sugars during or after activity?
- Are you using a temporary basal or decreasing your bolus when you are active?
- Does your insulin need to be adjusted with exercise?
- Are your meals balanced? Are you eating enough carbohydrates?
- Does the food contain hidden sources of sugar or fat?
- Do you have gastroparesis? This affects how your stomach empties. If you think you do, contact your diabetes nurse to discuss how to adjust your bolus settings.
- Have you started a new medication which causes high blood sugars? This might include prednisone, cortisone shots, and others.
- Are you having problems with your pump? Most problems are related to infusion sets and not the pump. Call the pump company’s 24 hour help-line. If the pump is failing or you are getting pump alarms, call them.
- Do you feel lumps when removing the infusion set?
- Is the infusion set painful to touch?
- Is there bleeding around or in the infusion set?
- Are there bubbles in the tubing or the cartridge/reservoir? Cold insulin can cause bubbles.
- Do you use the same sites or areas all the time? Do you change your infusion set every 2 to 3 days? The tissue needs time to heal before choosing that site again. If you have had diabetes a long time and use the same area for your injections, the tissue may not be healthy. This will affect insulin absorption.
Nutrition Guidelines to Prevent Dehydration
- Drink water and other liquids.
- Take small amounts of fluid every 10 minutes (8 ounces per hour is best).
- With vomiting and diarrhea, your body loses electrolytes like potassium and sodium. Replace these losses with bouillon, soups, sports drinks, juices, and other options listed below.
- Non-diet soda
- Sports drinks
- Cooked cereals
- Soups or bouillon
- Crackers or toast
- Sherbet or ice cream
Hint: White sodas that are warm and flat are better tolerated than cold, carbonated sodas.
- If you cannot eat your normal meals, replace carbohydrates with foods that have sugar. These foods must have sugar (regardless of your blood sugar level) to prevent the breakdown of your fat into ketones. You will need to take insulin to cover the sugar in the liquids and high blood sugar.
When To Call Your Diabetes Team (Phone Number: ________________________ )
- If your urine is positive to ketones.
- If you have symptoms of DKA.
- You are unable to control your blood sugar.
- If in doubt, go to the nearest Emergency Room. Do not delay treatment. Ketoacidosis needs to be treated right away. This can be life-threatening if not treated quickly. Discuss with your health care team when to use the Emergency Room.
Information You May Be Asked by Diabetes Team
- How long you have been sick.
- Current symptoms (especially those related to DKA).
- Blood sugar levels.
- Urine ketone levels.
- What you have been able to eat and drink.
- Your temperature (whether or not you have a fever).
- Amount of insulin taken.
- Last time you took insulin.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 02/10/2010
Copyright © 02/10/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#6979
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