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Insulin Pump Therapy

Diabetic Ketoacidosis Safety

​​​​​The Safety Kit

When on pump therapy, a safety kit must be carried and the user must follow safety precautions at all times (see below).

Everyone with type 1 diabetes should carry a glucose meter, as well as a fast acting source of carbohydrate to treat low blood sugars. However, those on an insulin pump will have additional items in their “safety kit” which will include items to help recognize and prevent DKA (ketone testing supplies, insulin and syringe/insulin pen), and items to keep the pump fully functional (an infusion set, battery and possibly other items).

​​​​​The Safety Precautions

If insulin delivery is interrupted for any reason, pump users must be ready to test their blood sugar and ketone levels, and to inject insulin by pen or syringe if needed. More diligence and more precautions are needed because of the increased risk of DKA in pump therapy.

Precautions to take:

  • Carry safety kit at all times!
  • Test blood sugar at least 4 times a day (at meals and bedtime) even if using a continuous glucose monitor. Remember, DKA can develop in 2-4 hours. If a mealtime blood sugar test is missed, the pump user might not be aware of high sugars from a kinked cannula. The next blood sugar test might show very high readings and ketones. Sometimes missing a blood sugar test means missing an opportunity to catch a problem and to prevent DKA.
  • Check infusion set or pod attachment 2 times a day
  • Change the infusion set every 2 to 3 days or sooner. Expect to change infusion sets at unexpected or inconvenient times when troubleshooting high readings.
  • Check blood sugar 2 hours after inserting a new cannula.
  • Have a written plan from your doctor or diabetes team member for which insulin(s) and doses to inject with syringe or insulin pen(s) if the pump stops working
  • Follow all the guidelines to prevent DKA if your blood sugars are over 14 mmol/L. Your educator will review these repeatedly with you. These can include:
    • checking for ketones. If ketones are present, you need more than your normal correction insulin to fix high blood sugars. Ketone testing is essential for preventing DKA.
    • injecting insulin by syringe or pen at times, even if the pump is working
    • testing glucose and ketones more frequently
    • drinking more fluids
    • visiting the emergency department if you have symptoms of DKA
    • troubleshooting pump functions, programming, infusion sites and sets.​

Knowledge Check

Sabina is on a pump. She leaves home to meet friends for dinner and a movie. She has her insulin pump, glucose meter, test strips, glucose tablets, back-up insulin vial, syringe and infusion set.

1. What is the key item that is missing from her safety kit?

 
 
 
 

Correct!Ketone strips or a ketone meter are needed. If ketones are present, she will need more insulin than her usual correction.

The correct answer is C.Ketone strips or a ketone meter are needed. If ketones are present, she will need more insulin than her usual correction.

Naveen is on an insulin pump. He has not checked his blood sugars since 6:00 am, when he changed his infusion set and cannula. It is now 11:30 a.m. He feels unwell with signs of high blood sugars.

2. Could Naveen have or be developing DKA?

 
 

Correct!It is possible his cannula is kinked or came unattached. DKA can develop in insulin pump users in a little as 2-4 hours. He needs to check his blood sugars (and ketones if > 14 mmol/L)

The correct answer is A.​​It is possible his cannula is kinked or came unattached. DKA can develop in insulin pump users in a little as 2-4 hours. He needs to check his blood sugars (and ketones if > 14 mmol/L) ​​​