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6. Diabetic ketoacidosis and insulin pump therapy

In this section, you’ll learn:

  • what is diabetic ketoacidosis (DKA)
  • why the risk of DKA is greater on insulin pump therapy
  • what insulin pump problems could lead to DKA
  • what items you need in your safety kit
  • what safety precautions you need to take

Diabetic ketoacidosis (also called DKA for short) is a problem that can happen because of diabetes. DKA happens when there isn’t enough insulin in your body. Too little insulin leads to a buildup of acids, called ketones, in your blood. DKA can cause death.

Why DKA risk is higher with insulin pump therapy

Anyone with type 1 diabetes can get DKA, especially when you’re sick. But people on insulin pumps have a much higher risk.

Remember that the insulin pump doesn’t use any intermediate-acting, long-acting, or ultralong-acting insulin. People on insulin pump therapy get only rapid-acting insulin. If their infusion stops and they don’t know, or they miss a bolus, they can have dangerously high blood glucose or DKA in just 2 to 4 hours. These problems can happen even when your blood glucose levels are normal or low at the time you stop getting insulin.​

Insulin pump problems that could lead to DKA

There are a few reasons why the insulin pump might stop giving insulin and cause DKA:

  • The infusion site (where the cannula goes into your skin) has been used for too long, is irritated, or infected.
  • The cannula or tubing has a bad connection, kink, or leak.
  • The pump stops working properly or a part breaks.
  • The pump programming isn’t working properly.​​