How to deal with high blood sugars when you have an insulin pump (CSII)

I’ve just changed my site and my blood sugars are very high (i.e. BG 16-18mmol/L). What should I do?

   1. Check the pump is operational (i.e. has not been left in ‘suspend’ or ‘auto-off’ mode).

   2. Verify basal & bolus rates. Check for temporary basal rate or not shut-off (is the auto-off in use?).

   3. Determine whether you did a fixed prime after attaching the new infusion set.

   4. Check the infusion site. Site occlusion is the most common cause of unexplained high sugars.

   5. Check the infusion set: verify that it is intact/look for air bubbles in tubing.

   6. If site and infusion set appear to be intact, then give a correction bolus of insulin.

   7. If you cannot find another reason, then assume the site is the problem.

      • A site change is recommended every 2 to 3 days. Site infections may occur if an aseptic (clean) technique is not observed or if the person attempts to use a site for an extended period of time.
      • If blood sugars > 16 -18mmol/L, always give an insulin injection using a pen/syringe. This will ensure you get the insulin dose, help lower your sugar, and minimize the risk of extremely high sugars/diabetic ketoacidosis.
      • Now you have time to assess whether the site needs to be changed.

     8.  Continue to test sugars every 1-2 hours and blood ketones every 4 hours until blood glucose levels stabilized.

How long can I be off my pump?

The insulin pump may be removed for showers, contact sports, endurance activities, swimming, or intimate moments.

  • Disconnecting the pump for up to approximately 90 minutes will usually not require additional action.
  • However, if the pump is off for a longer period of time, at least a portion of the missed basal insulin dose will have to be replaced with bolus insulin doses.
  • Waterproof pumps will allow for swimming for an extended period of time with the pump attached.

What do I do if my pump fails or stops working?

  • Immediately test your sugars (and ketones) and make the necessary dose corrections using an insulin pen or syringe (see sick day guidelines).
  • Call your insulin pump company’s 24 hour Customer Care Service.
  • You will need to give your insulin via injections (syringe/pen) until a replacement pump arrives.
  • You should have a back-up plan to replace basal insulin. You can use rapid insulin (take small doses of rapid insulin every 4 hours) or use a longer-acting insulin (N/NPH/Lantus or Levemir).
  • Contact your diabetes team if you need help.

    Steps to determining a temporary back up insulin dose:

       1. Determine your usual basal dose over 24 hours.

      • If using rapid acting insulin, divide your total base dose into 6 doses. (i.e. if total basal is 18 units » divide 18 units into 6 doses » take 3 units of insulin every 4 hours around the clock).
      • If using use a longer-acting insulin (N/NPH/Lantus or Levemir), divide your total base dose into 2 doses. (i.e. if total basal is 18 units »  divide 18 units into 2 doses » take 9 units of insulin twice a day, at breakfast and bedtime).

        2. Take your usual doses for all meal and snacks.

What do I do if I have an allergic reaction to the tape?

The good news is that most people do not have problems with the adhesive. But if you do, you may want to try the following:

  • Wash skin with soap & water and make sure your skin is completely dry prior to insertion. You can also try the following products:
      • Tegaderm
      • Hypafix
      • Antiperspirant to skin (reaction related to sweat on skin)
      • Bard Protective Wipes
      • Smith & Nephew Barrier Wipes
      • Bactroban, applied prior to insertion and after washing area with antibacterial soap
      • Polyskin transparent dressing
  • Mastisol (non-irritating surgical adhesive)
  • Ostomy paste

It's also a good idea to rotate your site regularly to ensure good absorption of the insulin, and make sure you always carry additional supplies with you for unexpected site changes/problems.

See more tape tips from

    Summer Tape Tips (from Medtronic Website)

Getting your infusion set tape to stick may be a challenge in the summer heat or when swimming. Try one of the following to help secure your site:

  • Check whether the tubing is pulling on the site
  • Use antiperspirant spray (not stick or roll-on) around the site
  • Medtronic IV Prep™
  • IV3000™ tape (apply to skin and then on top of the site)
  • Mastisol adhesive and its remover, Detachol

    Other tips:

  • Keep the infusion site clean-shaven/exfoliate (removing dead skins)
  • Stretch skin taut before using bonding agent or tape
  • Once you apply the tape, go back around the edge of the tape with the IV Prep pad to seal the edges to your skin
  • If all else fails, change the site!

For more information, contact the Insulin Pump Companies: