Managing High Glucose Levels and Ketones with insulin pumps (that are not Hybrid Closed Loop Systems)

This guide is for children and young people with type 1 diabetes, and their families, who use insulin pumps without a connected sensor.

✅Understanding Blood Glucose Targets

• Your target blood glucose levels are between 3.6 and 9 mmol/L.
• This target applies whether you're using a finger prick test or a continuous glucose monitor (CGM).
• Aim to stay in this range at least 70% of the time, and try to spend less than 4% of the time below 3.6 mmol/L.

📈When Glucose Is High

• Check and deliver any suggested correction bolus from the pump
• Check that you are using the lowest glucose target (in pump settings)
• Remember to change your infusion set/POD at least every 3 days

⚠️Watch for Infusion Set or POD Issues

Most cases of diabetic ketoacidosis (DKA) on insulin pumps happen due to:

• Infusion set/POD not working properly
• Insulin not absorbing well
• If your glucose stays above 14 mmol/L for more than 90 minutes, change the infusion set/ POD right away.
• If glucose and ketone levels are improving after the first set/POD change a second set/POD change is not required when following the step by step Guide.

High Glucose + Ketones = Act Fast

• If you have high blood glucose and ketones, it means your body doesn’t have enough insulin.
• You’ll need to increase your insulin dose
• Give extra correction boluses using an insulin pen, not the pump
• Only use rapid-acting insulin (e.g., NovoRapid, Humalog, Apidra, Fiasp or Lyumjev) for correction boluses.
• Set a temporary basal rate to increase insulin delivery → 200% or +95% for 4 hours
• Follow the step-by-step guide below

💧Keep Drinking Fluids

• High glucose + ketones = risk of dehydration
• Drink plenty of water or sugar-free fluids, especially if glucose is high

Using CGM when unwell

• Some medication may affect accuracy of CGM e.g. paracetamol.
• Dehydration means that the amount of fluid in the body is reduced, this can make sensors less accurate.
• Check a finger prick glucose to confirm sensor accuracy.

📞Need Help? Contact Us

• Emergency mobile: 07940 476 811
• Email:
  uclh.cdorange@nhs.net
  uclh.cddietitians@nhs.net

Further information and fact sheets can be found on our Children and Young People’s Diabetes web page.