Management of hyperglycaemia via a pump
Possible causes of High Blood Glucose Level (BGL)
Blockage or disconnection of infusion set or cannula falls out –
The insulin in the pump is rapid-acting so, if there is a blockage or disconnection of the tubing, or if the cannula has fallen out, the blood glucose will rise quickly.
Pump failure –
Although the pump performs many checks a day, to ensure it is working, you need to check there is sufficient insulin in the pump, the battery is working and that the pump is in ‘run’.
Cannula site –
Cannulas should be changed every 2-3 days, (depending on the type used). Sometimes they do not last quite as long as they should, which causes poor or variable absorption of the insulin so that they need changing sooner than expected.
Priming new cannulas –
When replacing a cannula, it is essential to prime the new cannula properly (especially for those with extension tube). If not, there will be a period of time when only air is delivered, not insulin, and will consequently cause the high blood glucose level to rise.
The pump will alarm if there is a problem, such as an occlusion, & to warn that the battery or insulin cartridge is running low. If these alarms are ignored, perhaps they happen during the night & are not heard, & the pump runs out of insulin or the battery fails, the required insulin dose will not be delivered, which will cause high BGL. The warning alarms for low battery or low cartridge insulin gives plenty of time to change things if they are responded to promptly.
Air Bubbles –
It is important to ensure there are no air bubbles in your insulin cartridge when you change it. Check it every day to make sure that air bubbles have not appeared. If they do, they can be primed out. If they are not spotted there will be times when no insulin is delivered, which will lead to rising BGL.