Insulin Pump Therapy

Insulin Pumps – Adjusting Basal rate (see also Top Tips No 1)

Target range for blood glucose

Pre-meal          5-7mmol/L

Bedtime           6-8mmol/L

2-3am            6-8mmol/L

Pre-breakfast   6-8mmol/L

Test should be abandoned if blood glucose goes lower than 4 or greater than 14mmol/L. Discuss with Diabetes Team about what to do.

Decide whether to test between: -

Breakfast to lunch

Lunch to tea

Tea to bedtime

Bedtime to breakfast

If you decide to test overnight Basal Rate:-

Start test at normal bedtime when bedtime blood glucose is within normal range and four hours after last snack. Do not take or give bedtime snack or bolus insulin. Test and record bedtime blood glucose.

Check blood glucose at 11pm (parents bedtime), 2-3am , 6am and before breakfast.

If you decide on checking daytime Basal Rate, choose which one to do:-

The test must start at least four hours after the last meal and bolus insulin.

Miss the next meal (breakfast, lunch or tea) and do not bolus insulin.

Test and record blood glucose at least every two hours until next meal.
Stop the test if your blood glucose goes too low (less than 4mmol/L).

Adjustment of insulin:-

When the test is complete, it is necessary to decide whether the basal rate needs adjusting.

If blood glucose has stayed within the target range (see above) then the basal rate for that period does not need adjusting. As a general principal the blood glucose should not vary more than 2mmol/L during the testing period.

If the blood glucose goes over the target range then the basal rate will need increasing. The insulin rate on the pump will need to be increased for the two hours before it was found to be high (e.g. if the blood glucose reading at 6pm is 10, then the insulin rate will need to be increased between 4-5pm). Discuss with the Diabetes Team how much to increase the rate. It is unusual to increase it by more than 0.1 units per hour.

If the blood glucose falls more than 2mmol/L or was below the target range, then decrease the insulin rate two hours before.

If the basal rate has been adjusted then it is important to recheck it within the next few days.

Write down the new basal rate on the chart provided and date it in case your pump fails. This provides a record if the pump has to be reprogrammed.

Do not hesitate to seek advice from the diabetes team if you are uncertain about what to do.

Disclaimer

This website is designed for use by the Leeds Paediatric Diabetes Team and children and parents referred to their service. Every effort has been made to make sure there are no errors on the website. If you think there are any inaccuracies could you please e-mail us so that we can check. kate.barker@leedsth.nhs.uk