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Hyperglycaemia (BGL 15mmol/L or higher)

Glucose readings above 7mmol/L overnight, on waking or before meals indicate that you are not getting enough insulin. Similarly, levels above 10.0mmol/L in the 2-3 hours after eating are above target.

If you are getting regular reading above these ranges, this equates to less overall Time in Range (TIR) and must managed to keep HbA1c in the target range <6.5%.

 Any ketones of 0.6mmol/L or higher on an insulin pump requires immediate action.

If the Ketones are 3.0mmol/L or higher AND your child is vomiting, you should give an ‘urgent dose’ of injected insulin (see below) and present to hospital for urgent medical assessment (as this is high risk for diabetic ketoacidosis which is a medical emergency).

When BGL is >15.0mmol/L, you need to follow the steps below:

Step 1: Check Blood Ketone levels (BKL):

1. If ketones are 0.6mmol/L or higher follow advice on the next page

2. If ketones are 0.5mmol/L or lower proceed to step 2.

Troubleshoot why BGL may be elevate

• When was the last bolus given? (use pump history and for Ypso on the pump swipe left to right)
  
• Is there insulin in the reservoir/cartridge?
  
  

  Tandem T Slim = 

  Medtronic = Status menu, number of units is indicated next to “Pump”

  Ypso = on the pump, under cartridge change the number of units in the pump is indicated 

• Has the line bent?
  
• Is there air in the line?
  
• Is the cannula site leaking? – Can you smell insulin?
  
• Is the cannula site infected? (red/painful/tender to touch – consider GP assessment if infection is suspected)

Step 2:

Hybrid Closed Loop (CamAPS, Control IQ, SmartGuard) 

• No immediate action is required. Allow the algorithm (Hybrid Closed Loop) to correct the elevated glucose levels. 
• Monitor closely. 

Manual Mode (Not currently using SmartGuard, CamAPS or Control IQ) 

• Enter BGL into the pump and receive a correction dose. 
• Avoid eating carbohydrates until you are sure youare receiving insulin (you will know this because your glucose levels will lower after the correction dose is given) 

Step 3: 

If BGL’s are lower, your line is working. Continue to monitor BGL until they are back within target range.

• If BGL’s are unchanged or higher, check ketones. If ketones are >0.6mmol/L, follow advice on next page. If ketones <0.5mmol/L, complete full line and cannula change, correct elevated BGL with new line and recheck BGL in 2 hours. 
• When BGL is15.0mmol/L or higher AND BKL 0.6mmol/L or higher, you need to assume this is line failure requiring urgent management.

Urgent line failure management: BGL is 15 mmol/L and ketones are 0.6 mmol/L or higher

High blood glucose levels AND high blood ketone levels = Not enough insulin in the body!

Pump therapy carries a higher risk for developing ketones compared to other insulin regimens because only rapid acting insulin is used (i.e. no long acting insulin) and line failure or disconnection can happen.

• You need to have ready access to rapid acting injectable insulin (e.g. pen insulin device) at all time as an alternative way of giving insulin.
• A ketone reading of 0.6mmol/L or higher, associated with BGL 15.0mmol/L or higher needs immediate treatment with an “urgent dose” of injected rapid acting insulin via pen/syringe.
  Follow the steps below.

Calculate “urgent dose” by dividing your pump total daily dose (PTDD) of insulin by 6.
Give “urgent dose” of rapid acting insulin via pen/syringe. DO NOT use the pump to give this urgent dose as we must assume your line is not working.

PTDD is accessed in your pump history or from your download report  

• Medtronic: History – Summary – 7 Days - calculates a 7 day average or on your Carelink report 
• Tandem: T SLIM: Options – Pump History – Delivery Summary – 7 Day Average or on your Glooko report 
• Ypso CamAPS: CamAPS app - main menu and statistics or on your Glooko report

1. Disconnect the pump from your body. You will need to complete a bolus into the air for the “urgent dose” injected. The injected insulin will be registered in the pump as Insulin on Board. To do this, enter your BGL into the pump and change the recommended bolus to the amount given as the “urgent dose”. Deliver this insulin into the air

2. Complete a full insulin reservoir, line and cannula change and reconnect pump.

3. Re-check fingerprick BGL and BKL

After 2 hours:

• If BGL is 15.0mmol/L or higher and ketones are 0.6mmol/L or higher, repeat step 1 and give another urgent dose. A line change is not required.
• If BGL is 15.0mmol/L or less and your ketone levels are lower than they initially were, enter your BGL and any carbohydrates consumed into the pump and receive insulin bolus.
  

Continue close monitoring and seek medical attention if you have any concerns

Page updated September 2024