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Printed at: 12:29:36 / 01-03-2021

High Blood Glucose Levels (Hyperglycaemia) On Pump Therapy

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What is hyperglycaemia?
Target blood glucose level is between 4 and 7 mmol/l. Hyperglycaemia is when the blood glucose level is too high. High blood glucose levels could be a sign that the body is producing ketones, which are dangerous. Ketones are acids which can quickly make you feel very unwell. They may make you vomit or make you feel breathless. If you do not get rid of ketones, you can become extremely unwell and would need urgent hospital treatment (diabetic ketoacidosis).

Why levels may rise
If you are unwell – illness will impact on diabetes control and often when you are unwell, your body needs extra insulin to keep your glucose levels within range. Remember – if blood glucose levels are 14mmol or above, test for ketones and follow the guidance on the “Treatment of High Blood Glucose Levels on Pump Therapy” leaflet. Pump failure – the pump performs many self checks each day but you must ensure it is in RUN, that there is enough insulin in the pump and that the batteries are working.

Cannula site problem or cannula falls out – Check the cannula is still in place. High blood glucose levels could be a sign that the cannula is not working effectively. Sometimes they do not last as long as they should which can cause poor or variable insulin absorption. Priming a new cannula – remember to always prime your new cannula. Failure to do so can lead to an interruption of insulin being delivered as only air is being delivered. This will have a ‘knock on’ effect and cause high blood glucose levels.

Blockage or disconnection of infusion set – the insulin in the pump is rapid-acting insulin. Therefore, if there is a blockage or it has been disconnected, this will cause high blood glucose levels.

Alarms – Do not ignore any pump alarm. The pump will alarm if there is a problem such as low battery, insulin running low or occlusion (blockage). The warning alarms for low battery/low insulin allow you plenty of time to change things if you respond to them promptly.

Air bubbles – air bubbles either in the insulin cartridge or tubing can be primed out. If there are air bubbles present, there will be times that insulin is not being delivered and this will lead to high blood glucose levels. It is important to always check when changing and also have a look on a daily basis
to ensure none have appeared.

Hot weather – during very hot spells or if on holiday the insulin may be affected by the heat. Hot weather and your own body heat can affect the insulin and it may not last as long as usual. It is
advisable to change the insulin more frequently during extremely hot weather if you are experiencing higher levels.

Bolusing – did you forget to bolus with the last meal or the meal bolus was not enough? If you are finding that on a regular basis, blood glucose levels are rising after meals, it may be that the insulin to-carbohydrate ratio needs reviewing. Please contact the team for advice if you are unsure.

The insulin – the following could affect insulin and subsequently affect blood glucose levels – Has the insulin expired? Has it been left in extreme temperatures? How long has it been in the cartridge for? (if applicable).

Stay safe by:
• Testing frequently
• If blood glucose is 14mmol/L or above, test ketones
• If unwell, test for ketones regardless of blood glucose levels
• Always carry a spare insulin pen and pen needles