Hyperglycemia is a complication of diabetes that occurs when the body cannot use sugar (glucose) as its main fuel source. When blood sugar levels raise high enough, our bodies turn to burning fat and muscle for energy. The byproducts of this process is an acid called ketones.
You might be asking yourself, “What’s wrong with that?” Well, nothing. As long as it doesn’t happen in excess, because when you flood your body with too many acids, it starts to become toxic. When combined with dehydration, it can lead to a life-threatening condition called diabetic ketoacidosis (DKA).
Wearing an insulin pump raises your risk of developing diabetic ketoacidosis (DKA), compared to when you took a long acting insulin
This is because you are now using a continuous drip of rapid acting insulin for your basal needs, with each dose lasting only 4-5 hours. So, DKA can develop if there is a prolonged interruption of insulin delivery.
When your blood glucose is 250 mg/dL or more, your first course of action is to troubleshoot causes to rule out a pump or infusion set/site issue. Make an effort to address any preventable causes so that they happen less and less often as you learn how to manage your diabetes.
Check for DKA if your BG is more than 250 mg/dL with
- Moderate or large urine ketones, or
- Value greater than 1.0 mmol/L with blood ketone meter
Troubleshooting Pump-Related Issues
Your pump may not be delivering insulin. If the pump problem/malfunction cannot be fixed promptly, insulin must be given by syringe. Call your pump manufacturer’s technical support number which is located on the back of your pump.
Assess for the following
- Infusion cannula: dislodged, kinked or pulled out
- Infusion set clog, leaks, bubbles/air in tubing
- Pump suspended for longer than 30 minutes
- Pump malfunction
- Bad site: too close to scar or navel, poor absorption, site in use for too long
Treating Hyperglycemia / Preventing & Treating DKA
When symptoms are severe or not responding, it is always best to go to the hospital where fluid, insulin and electrolyte replacement can be provided and the underlying cause (if it is an illness or infection) can be treated.
Palo Alto Medical Foundation: Pre Pump Education Packet