CSII Sick Day Management

Anne Bossy, nurse from the Insulin Pump Centre, gives you her advice.

• Never omit basal insulin. Do not disconnect or stop insulin pump unless patient is receiving insulin by injection.
• Increase frequency of blood glucose and urine ketone monitoring to every 2 to 4 hours throughout the entire day and night.
• During illness, increase basal rate by 20% to 50% until illness resolves and blood sugars are back in range.
• Adjust boluses to carbohydrates intake. Increase boluses by 20-50% as needed to return blood sugars to their targets range.
• Increase fluid intake as needed to help clear ketones.
• Examine infusion site as possible source of occult infection and cause of hyperglycaemia and ketosis.
• Check pump and infusion device. If blood sugars and ketones remain elevated for more then 3-4 hours (see hyperglycaemia protocol), give supplemental insulin by syringe or pen. Determine the dose according to your usual correction x 1.5 (e.g. usually 10 units x 1.5 = 15 units). Change pump infusion set-up. Call the diabetes doctor on call.
• Call health care team if patient has persistent nausea or vomiting for more than 4 hours, if symptoms of diabetic ketoacidosis develop (chest or abdominal pain, deep breathing) or if question or concerns arise.

03-01-07 – Montreal Children’s Hospital