Guidelines for Successful Pumping

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.