Insulin pump hyperglycaemia and sick day management plan

Insulin pump hyperglycaemia and sick day management plan

Having a sick day management plan is essential for preventing emergencies and hospital visits when you have type 1 diabetes.

Download fact sheet

When you're unwell or have an infection, your blood glucose levels can rise unexpectedly, requiring careful monitoring and insulin adjustments through your insulin pump.

This guide has been developed specifically for people using insulin pumps, not multiple daily injections. It should be used in consultation with your healthcare team to ensure safe and effective diabetes management during illness.

What you will learn in this fact sheet

This fact sheet provides critical information for managing hyperglycaemia with an insulin pump.

  • When to activate your sick day management plan.
  • Step-by-step insulin adjustment guidelines based on blood glucose and ketone levels.
  • Nutrition and hydration strategies during illness.
  • What to include in your sick day kit.
  • Signs of emergency requiring immediate medical attention.

When to use your sick day management plan

Activate your sick day plan when:

  • You are unwell or have an infection, even if your blood glucose level is normal.
  • Blood glucose levels are higher than 13mmol/L for 6 hours or more, even if you feel OK.
  • You have ketones in your blood or urine.
  • Based on previous experience (for example, if you have an infection or are taking steroid medication).

Key steps to take

  1. Test your blood glucose level and adjust insulin
    Monitor blood glucose regularly and adjust insulin according to the guidelines in this fact sheet.
  2. Test your blood or urine ketone levels
    Check ketones as per sick day recommendations and adjust insulin accordingly.
  3. Continue to take your insulin
    Never stop your insulin pump. Extra insulin may be required depending on your blood glucose and ketone levels.
  4. Try to continue to eat and drink
    Maintain hydration and nutrition if possible. Aim for 125–250ml of fluid per hour.
  5. Seek urgent medical attention
    Go to your nearest emergency department if you remain unwell, your blood glucose level is not coming down, or if your ketones measure more than 3mmol/L.

Insulin adjustment guidelines

Your insulin adjustments depend on both your blood glucose levels and ketone levels. Always work with your healthcare team to understand these guidelines.

If blood glucose is less than 4.0mmol/L:

  • Blood ketones less than 0.6mmol/L
    Treat hypoglycaemia as usual. Recheck in 15 minutes. Once levels return to target, recheck glucose and ketones in 1 hour. Consider reducing basal rate by 20% for 2–4 hours if persistently low.
  • Blood ketones more than 0.6mmol/L
    Treat hypoglycaemia as usual. Change cannula and reservoir. Recheck in 15 minutes. Once levels return to target, recheck glucose and ketones in 1 hour.
  • Blood ketones more than 1.5mmol/L
    Treat hypoglycaemia as usual. Change cannula and reservoir. Recheck glucose and ketones hourly until normalised.
  • Blood ketones more than 2.0mmol/L
    Seek urgent medical attention.

If blood glucose is 4.1–8.0mmol/L:

  • Blood ketones less than 0.6mmol/L
    Continue normal basal rate. Use normal bolus advice for carbohydrates and correction. Drink fluids containing 15–20 grams carbohydrate. Recheck in 2 hours.
  • Blood ketones 0.6–1.5mmol/L
    Change cannula and reservoir. Give bolus of 5–10% of pump total daily dose. Continue every 2 hours until ketones below 0.6mmol/L. Drink fluids containing 15–20 grams carbohydrate. Recheck in 2 hours.
  • Blood ketones more than 1.5mmol/L
    Change cannula and reservoir. Give bolus of 10–15% of pump total daily dose. Continue every 2 hours until ketones below 0.6mmol/L. Drink fluids containing 15–20 grams carbohydrate. Recheck in 2 hours.
  • Blood ketones more than 2.0mmol/L
    Seek urgent medical attention.

If blood glucose is 8.1–13.0mmol/L:

  • Blood ketones less than 0.6mmol/L
    Continue normal basal rate. Use normal bolus advice. If still high after two corrections, consider temporary basal increase of 10–20% for 2 hours. Recheck in 1–2 hours.
  • Blood ketones 0.6–1.5mmol/L
    Change cannula and reservoir. Give bolus of 10–20% of pump total daily dose every 2 hours. Consider temporary basal increase of 10–20% for 2 hours. Check glucose and ketones hourly.
  • Blood ketones more than 1.5mmol/L
    Change cannula and reservoir. Give bolus of 20–30% of pump total daily dose every 2 hours. Consider temporary basal increase of 10–30% for 2 hours. Check glucose and ketones hourly.
  • Blood ketones more than 2.0mmol/L
    Seek urgent medical attention.

If blood glucose is more than 13mmol/L:

  • Blood ketones less than 0.6mmol/L
    Use normal bolus advice for carbohydrates and correction. Recheck in 1 hour.
  • Blood ketones 0.6–1.5mmol/L
    Change cannula and reservoir. Give bolus of 10–20% of pump total daily dose every 2 hours. Run temporary basal increase of 20–30% for 2 hours. Check glucose and ketones hourly.
  • Blood ketones more than 1.5mmol/L
    Change cannula and reservoir. Give bolus of 20–30% of pump total daily dose every 2 hours. Run temporary basal increase of 30–50% for 2 hours. Check glucose and ketones hourly.
  • Blood ketones more than 2.0mmol/L
    Seek urgent medical attention.

IMPORTANT: Seek urgent medical attention if blood glucose levels or ketones continue to increase after two extra doses of insulin, or if blood glucose levels don't start to decrease.

Supporting vital diabetes research

This evidence-based fact sheet was developed by the Baker Heart and Diabetes Institute, where our team provides specialist diabetes education and insulin pump services.

Help us continue providing free, expert health resources. Your support enables us to develop more comprehensive fact sheets for diabetes management, conduct research that improves outcomes for people with type 1 diabetes, and make evidence-based health information freely accessible to all Australians.

Support our research and free resources

Nutrition and hydration tips

To avoid dehydration, keep drinking and eating if possible. Aim for 125–250ml of fluid per hour.

  • If blood glucose levels are less than 15mmol/L
    Have fluids containing carbohydrate (15–20 grams per hour) such as fruit juice, soft drink, milk or sports drinks.
  • If blood glucose levels are more than 15mmol/L
    Have fluids which don't contain carbohydrates (125–250ml per hour) such as water, diet soft drink, Powerade Zero, diet cordial, diet jelly or broth.\

Contents of a sick day kit

Your sick day kit should include:

  • Copy of your sick day plan.
  • List of important telephone numbers.
  • Glucose meter and testing strips.
  • Ketone meter and test strips.
  • Blood glucose diary.
  • Thermometer.
  • Pain relief medication.
  • Food and drink for sick days.
  • Hypoglycaemia treatment.
  • Insulin pens and needles.
  • Cannula and reservoir (×2)
  • Insulin.

Check your sick day kit every 6 months to ensure items are in date and restock as required.

Signs and symptoms of an emergency

Seek urgent medical attention if you experience:

  • extreme thirst
  • going to the toilet often
  • nausea and vomiting
  • stomach pain
  • weakness or fatigue
  • shortness of breath
  • fruity scented breath
  • confusion
  • high glucose
  • high ketones.

Download your free fact sheet

Download fact sheet

Need personalised advice?

For individual guidance on insulin pump management tailored to your needs, contact the Baker Institute's insulin pump service.

Disclaimer
While reasonable efforts have been made to ensure the accuracy of this material, the information is provided on the basis that persons undertake responsibility for assessing the relevance and accuracy of its content. In particular, readers should seek independent professional medical advice from their general practitioner or specialist in relation to their own individual circumstance or condition before making any decisions based on this information. The material also includes summarised guidelines or recommendations based on information provided by third parties. The Baker Heart and Diabetes Institute disclaims to the extent permitted by law, all liability including negligence for claims of losses, expenses, damages and costs that the reader may incur (or suffer) from acting on or refraining from action as a result of all information in these materials.