High blood sugar or Hyperglycemia is a blood sugar greater than 250 mg/dl. Typical reasons for hyperglycemia may include: expired insulin, sickness, or not enough insulin to cover a meal or forgetting to take insulin.
If using an insulin pump, hyperglycemia can lead to diabetic ketoacidosis (DKA) if not quickly managed. Symptoms of DKA may include nausea and vomiting, fruity breath, chest or stomach pain, very dry skin and lips, labored breathing, confusion. Your urine may have ketones if you are at risk for developing DKA. If not treated quickly, DKA can make you very sick.
Pump related causes for Hyperglycemia or DKA can include:
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mechanical problems |
cannula becoming loose or bent |
running out of insulin |
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bubbles in the tubing |
infection at the infusion site |
illness |
Below are steps to troubleshoot and treat hyperglycemia when blood sugar levels are greater than 250 mg/dl:
- Try to identify what the reason is for the hyperglycemia – for example, is the pump still working? Did you forget to take insulin or not take enough insulin? Is your insulin expired? Remember If you are sick and not eating, you may need extra insulin.
- Check for Urine Ketones:
Negative-small ketones
- Take a correction dose with the pump. If your pump is disconnected, calculate your correction and inject short acting insulin with your pen or vial & syringe.
- To calculate your correction dose:
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= |
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÷ |
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= |
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Your BG |
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Target BG |
= |
How much higher is your BG |
÷ |
Correction Factor |
= |
Amount of insulin needed for correction |
OR
- Take 10% of your total daily dose (TDD) which you can obtain from your pump or you can calculate from your total basal rate plus the bolus insulin you take per day
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x |
0.1 |
= |
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Your TDD |
x |
10% |
= |
Your correction dose |
- Re-check your glucose 2-3 hrs. If your glucose decreases, continue your activities as usual. If your blood glucose does not decrease or is higher:
- Re-check for urine ketones – if ketones are not improving or higher, take a correction via pen or vial and syringe injection
- Change your pump infusion site
- If your blood sugar does not decrease or is higher 2-3 hours after the injection Call your diabetes team!
Moderate to large ketones
- Take a correction dose via injection (pen or vial and syringe) using your correction factor
OR
- Calculate a correction dose by taking 20% of your total daily dose which you can obtain from your pump or you can calculate from your total basal rate plus the total amount of bolus insulin you take per day:
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x |
0.2 |
= |
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Your TDD |
x |
20% |
= |
Your correction dose |
- Change the infusion site for your pump
- Drink plenty of decaffeinated and calorie-free drinks
- Recheck your sugar in 2 hours make sure it is decreasing by at least 50 mg/dL per hour
- If your glucose does not decrease in 2-3 hours or is higher Call your diabetes team!
- Remember - If your glucose does not improve after two additional insulin doses, call your diabetes team!
- When your glucose is high for a long period, it will take some patience, time, and sugar free decaffeinated fluids to lower your blood glucose.
- If your pump is not working properly and you need to be off the pump for more than 2 hours, short acting insulin doses will be necessary every 3 to 4 hours and you may need to restart long acting (basal) insulin. Follow your instructions from your diabetes team and call if you have any questions.
What to Drink or Eat When Feeling Sick
Sugar Free Options
- Water
- Diet soda
- Diet gingerale
- Unsweetened tea
- Sugar-free Jell-O
- Broth (bouillon cubes)
- Sugar-free Kool-Aid or juice mix
- Sugar-free popsicles
If you are not eating well and need foods with calories:
15 gram carbohydrate choices
- ½ cup fruit juice
- ½ cup regular soda
- 1 cup (8 oz) sports drink (Gatorade, Powerade)
- 1/3 cup applesauce
- ½ cup regular Jell-O
- ¼ cup sherbert
- ½ cup ice cream (vanilla)
- ¼ cup sweetened pudding
- ½ cup sweetened fruit yogurt
- ½ cup cooked hot cereal
- 1 slice bread or toast
- 6 saltine crackers
- 5 lifesaver candies
- ½ cup plain noodles (cooked)