Troubleshooting Ketones on an
Insulin Pump
Ketones can develop anytime your body is not receiving enough insulin. The most common reasons ketones develop on an insulin pump are due to the following:
- the infusion set is coming off
- the infusion set tubing becomes clogged by blood in the tubing
- the catheter (cannula) becomes bent or crimped or leaks along the tubing or at connection sites where you disconnect or where the tubing attaches to the reservoir (cartridge)
Ketones can also form if you are sick and unable to eat foods containing carbohydrate for energy. Instead of burning glucose from carbohydrate for energy your body starts to burn fat which makes acids called ketones.
Symptoms of ketones include stomachache, vomiting, and nausea.
If you have a blood glucose above 240 or if you have symptoms of ketones check
your urine or blood for ketones NO MATTER WHAT YOUR BLOOD GLUCOSE READING IS.
- Check blood glucose levels every 2 – 4 hours, and record on sick day record.
- Check urine or blood ketones if blood glucose is 240 or above or if your child is vomiting, nauseous, has stomach pain, or an illness regardless of the blood glucose result.
- Always check urine ketones no matter what the blood glucose each time your child goes to the bathroom.
A. If blood glucose is greater than 240 do the following:
For trace/small ketones and blood glucose is elevated:
1)Refer to “Preventing Ketosis When Using A Pump”
2)Give a correction bolus using the insulin pump
3)Encourage water or other sugar free fluids to stay hydrated
4)Check blood glucose and ketones 2 hours after bolusing to make sure blood glucose and ketones are decreasing
For moderate ketones with blood glucose over 240:
1)Refer to “Preventing Ketosis When Using A Pump”
2)Give correction bolus using an insulin pen or syringe equal to 10% of the Total Daily Dose, TDD (find 3 day average total daily dose in pump history menu)
3)Change infusion site
4)Follow steps 3 and 4 as above
For large ketoneswith blood glucose over 240:
1)Refer to “Preventing Ketosis When Using a Pump”
2)Give correction bolus using an insulin pen or syringe equal to 20% of theTotal Daily Dose, TDD (find 3 day average total daily dose in pump history menu)
3)Change infusion site
4)Follow steps 3 and 4under trace/small ketones
B. If blood glucose is less than 240 with moderate or large ketones:
1) Have your child eat or drink carbohydrate containing food or fluid (see below)in order to increase blood glucose to 200 or greater so additional Humalog,Novolog, or Apidra insulin can be given as above.
Adjust eating plan to allow meal and snack carbohydrate to be spread
over 4 hours, use liquid diet as needed. You must get carbs in!
Examples of 15 grams carbohydrate:
½ cup juice / 4 – 6 ounces decaf/regular soda / 1 cup regular sport drink½ twin popsicle / ½ cup regular gelatin / 8 saltine crackers
1 cup cream/noodle soup / ¼ cup sherbet / ½ cup applesauce
1/3 cup rice or pasta / ½ cup pudding / 1 slice bread or toast
2)You can give extra Humalog, Novolog, or Apidra insulin through an insulin
pen orsyringe2 hours after the first dose is given if urine ketones remain
moderate or large.
3)If you continue to have moderate or large urine ketones 2 hours after giving a second dose of additional Humalog, Novolog, or Apidra call your diabetes team immediately!!
Call (816) 234-1660 or Toll-Free (888) 563-3070.
After 4:30 p.m. call (816) 234-3000 and
ask for the diabetes doctor on-call.
References
The Children’s MercyHospital and Clinics Diabetes Center Clinical Practice Guidelines.
Walsh, J. & Roberts, R. (4th ed). (2006). Pumping Insulin. San Diego: Torrey Pines Press.
Wolpert, H (2002). Smart Pumping for People with Diabetes. American Diabetes Association.
March 2008