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.