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Diabetes at the RCH

Insulin pump line failure

  • Insulin pump line failure: BGL of 15 mmol/L or higher with ketones of 0.6 mmol/L or higher 

    High blood glucose + ketones = Not enough insulin in the body

    • Insulin pump therapy carries a higher risk for developing ketones compared to other insulin regimens because only rapid acting insulin only is used
    • Insulin pump users need to have access to rapid acting injected insulin at all times as an alternative way of giving insulin e.g. NovoRapid® Flexpen or Humalog® Kwikpen.
    • A ketone reading of 0.6mmol/L or higher is positive and if associated with BGL 15.0mmol/L or higher needs immediate treatment with an 'urgent dose' injected insulin (see below) via pen or syringe

    Step 1

    • Calculate 'urgent dose' by dividing your pump total daily dose (PTDD) of insulin by 6
    • Give 'urgent dose' of Novorapid®/Humalog® via pen or syringe.
      Do not use the pump to correct the high BGLs.
    • Disconnect the pump from your body.
    • Enter the BGL in the pump, change the recommended bolus to the urgent dose just injected and deliver the insulin correction into the air.
      This will keep a record of the BGL and the injected insulin in the pump. Your injected insulin will be calculated in your pump active insulin.
    • Complete a full insulin reservoir, line and cannula change and reconnect your pump. It is ok for basal insulin to be running at this time.

    Urgent dose will change as PTDD changes. Please update this dose regularly.

    PTDD is accessed in you pump history or from your download report:

    • MEDTRONIC – History – Summary – 7 Days
    • T SLIM: Options – Pump History – Delivery Summary – 7 Day Average
    • Ypso CamAPS: CamAPS app - Main Menu and statistics or on your Glooko report

    Step 2

    • Re-check BGL and ketones in 2 hours
      • If ketones are 0.6 mmol/L or higher and BGL is 15 mmol/L or higher, repeat step 1 (inject pen insulin using the 'urgent dose'), however a line change is not required. Unless you are confident with appropriate action, seek urgent medical advice. Continue close monitoring.
      • If ketones are 0.6 mmol/L or higher and BGL is 14.9 mmol/L or lower, enter your BGL and any carbohydrate consumed into the pump and give the calculated bolus. Continue close monitoring and seek medical attention if any concerns.
      • If ketones are 0.5 mmol/L or lower, Bolus as usual through your insulin pump.

    • Continue to re-check your BGL & Ketones two hourly until BGLs are less than 15mmol/L and ketones 0.5 mmol/L or lower.

    You will not know your new line is working until the effect of your injected insulin has finished. Be aware – Every line change carries the risk of line failure.

    Updated October 2024

  • Seek urgent medical attention or call an ambulance by dialing 000 if: 

    • You have had 3 vomits or diarrhoea or continued stomach pains, especially if these pains are associated with high BGLs.

    • If at any stage, ketones are 3.0 mmol/L or higher, you should give an 'urgent dose' of rapid acting insulin as explained above and present to hospital for urgent medical assessment. This situation has a high risk of diabetic ketoacidosis (DKA) which is a medical emergency.  Remember signs of DKA include; vomiting, stomach pain, rapid breathing, drowsiness.

    • After following the above advice, ketone levels are increasing or remain 0.6 mmol/L or higher. 

    The Royal Children's Hospital (RCH) Sick day service phone number 9345 5522 ask for the 'Diabetes sick day call' 7am – 4.30pm Monday – Friday (for patients of the RCH).