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130 Chapter 10
Adverse reactions
Hyperglycemia and diabetic ketoacidosis (DKA)
Pump wearers use only regular short-acting insulin. As a result,
they do not have a reserve of long-acting insulin.
You must be aware that interruption of insulin delivery (due to
infusion set clogs, leaks, loss of insulin potency, or pump malfunc-
tion) can result in a rapid rise of blood glucose levels within two to
four hours and the development of DKA within four-to-ten hours.
The onset of stress or illness (caused by infection or an emotional
event) can result in a rise of blood glucose levels and the develop-
ment of DKA.
Although the pump has multiple safety alarms, it cannot alarm if
the set is leaking or the insulin has lost its potency.
It is essential, therefore, that you test blood glucose levels at least
four times per day. If your blood glucose levels are high (over 250
mg/dl or 13.7 mmol/L), you must be prepared to give an injection
of regular insulin. You need to troubleshoot the pump and the infu-
sion set to ensure that the necessary amount of insulin is being
delivered.
You also should check for urine or blood ketones whenever your
blood glucose is elevated above 250 mg/dl (13.7 mmol/L) and take
an insulin injection. Establish a plan with your healthcare profes-
sional for rapidly identifying and treating hyperglycemia, to pre-
vent the onset of DKA and possible hospitalization.