Paediatric Clinical Guideline

Section: Endocrinology 9.4 Diabetes – Management of patients on insulin pumps

Short Title: / Management of patients on insulin pump therapy
Full Title: / Guideline for themanagement of patients on insulin pump therapyin children and young people
Date of production: / November 2008
Explicit definition of patient group to which it applies: / This guideline applies to all children and young people under the age of 19 years under the care of the paediatric team.
Name of contact author / DrTabitha Randell, Consultant in Paediatric Endocrinology and Diabetes
Revision Date / April 2010
This guideline has been registered with the Trust. However, clinical guidelines are 'guidelines' only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt contact a senior colleague or expert. Caution is advised when using guidelines after the review date.

Management of patients on insulin pump therapy

High Blood Sugars

  1. Check have given correction dose (all patients should know their correction dose i.e. how much their sugar will drop after 1 unit of insulin) and make sure they are correcting down to 6 mmol. E.g. – blood sugar level 15, correction dose 1 unit reduces by 3 mmol so will need to give 3 units extra insulin via pump. Recheck sugar level in 1 hour. If blood sugar 15 or above, make sure have checked blood ketone level. Above 1.5 corresponds to large ketones on urine testing – go straight to step 2.
  2. If blood sugar after two hours has not come down by more than 4 mmol or has increased, or if ketones have not come down or increased, change giving set and give a further correction bolus after changing the set. Repeat blood glucose level after 1hour.
  3. If blood sugar level has not come down by more than 4 mmol or has increased, or ketones have not come down or increased, give a further correction dose of quick acting insulin BY PEN INJECTION.
  4. The family will then need to contact the relevant pump company (all have 24 hour telephone helplines) as there may be a problem with the pump.
  5. All children and young people on insulin pumps should have short acting and long acting insulin in pens as emergency back up. The amount of long acting insulin will be whatever their total daily basal rate is PLUS 20% (e.g. basal rate = 20 units/day, give 24 units long-acting insulin). Quick acting should be given at the same rates as used on the pump.

Low Blood Sugars (i.e.below 4 mmol/l)

  1. Give 10g quick acting carbohydrate (3 dextrose tablets, 100ml lucozade).
  2. Recheck after 10 mins
  3. If still low, give further dose of quick acting carbohydrate as above.
  4. Pump patients DO NOT need additional carbohydrate after quick acting when treating a hypo
  5. If having something extra to eat e.g. biscuits, sandwich, MUST cover with a bolus of insulin using normal carbohydrate ratio.

FURTHER ADVICE CAN BE SOUGHT FROM THE CONSULTANT ON-CALL FOR PAEDIATRIC ENDOCRINOLOGY – CONTACT VIA SWITCHBOARD

Dr Tabitha RandellPage 1 of 2November 2008