Insulin requirements regularly change. When using a pump, changes to insulin doses means making adjustments to your pump settings. It is important for families to learn the skills to adjust insulin delivery in response to glucose patterns. Review your pump upload weekly to look for patterns in your glucose levels (e.g. out of target glucose levels for 3 days in a row OR at the same time of day for 4/7 days). Wait 3 days to assess the effects of any changes of any setting changes before making another change. 

Glucose targets: 

• Target glucose levels are 4.0 mmol/L- 7.0mmol/L pre meals
• Time in Range on Continuous Glucose Monitoring more than 70% 
  
• Target HbA1c is less than 48 mmol/mol (less than 6.5%)

Pump terms reference guide: 

Bolus Insulin:

• Carbohydrate Bolus: insulin to carbohydrate ratio (ICR). Insulin delivered following entry of carbohydrate to be consumed.
  
• Correction Bolus: Insulin sensitivity factor (ISF)/ Correction Factor (CF). Insulin delivered to correct an above pump target glucose level. 

Basal insulin: Background insulin delivered continuously. 

Follow the below general guidelines for making safe adjustments:

1. If experiencing out of target (hypo/hyperglycaemia) glucose readings overnight or more than 4 hours after food – adjust the basal insulin by 10%, starting at least 2 hours prior to out of target time.
2. If experiencing out of target (hypo/hyperglycaemia) glucose readings 3 hours after a meal bolus – adjust the insulin to carbohydrate ratio by 10%.
3. If experiencing out of target (hypo/hyperglycaemia) glucose readings 3 hours after a correction (and no food bolus has been given) – adjust the insulin sensitivity factor by 10%.

Note – if using Hybrid Closed Loop (HCL) i.e. SmartGuard, CamAPS, Control IQ, there are some pump settings that cannot be altered due to the pumps HCL algorithm.

The below table outlines exactly what pump settings can be altered according to the pump and the mode in which it is being used.

Page updated September 2024