Common Questions
2. Do I need to check for ketones even though I am on the pump?
Yes, there are times when it is important to check for ketones, but hopefully not often. The insulin pump uses only fast acting insulin; so if delivery is impaired (a bad infusion site, the infusion set cannula slips out of your skin, the cartridge and tubing connection is loose) blood glucose levels can elevate quickly.
A safe guideline is to check for ketones any time your blood glucose is over 250 and you don't know why. If ketones are positive, this means that insulin levels are very low and your body can't use glucose and has needed to burn fat for fuel. Ketones make your blood highly acidic, which causes you to feel nauseated and vomit, and can rapidly lead to dehydration. If left untreated, this can lead to DKA (diabetic ketoacidosis), which is a medical emergency.
Signs and symptoms of DKA may include nausea and vomiting, abdominal pain, a fruity odor on your breath, shortness of breath or breathing fast. If you have any of these symptoms, you should seek medical attention immediately.
There are a couple of easy ways to test for ketones at home. One is by using a urine ketone test strip.
The second way to monitor ketones at home is with a special blood glucose meter that can measure ketones. Ketones show up in the blood up to 4 hours before the urine. This can be a great advantage in preventing the progression from ketones to DKA.
More info on treating ketones and DKA prevention can be found by asking your health care team, or in the book "Pumping Insulin" by John Walsh.
Remember, testing for ketones using the above guidelines along with frequent blood glucose testing, can decrease the likelihood of developing DKA. If ketones are present, you should follow your healthcare professional's instructions for taking an extra amount of fast-acting insulin by injection, not by the pump, and drink plenty of sugar-free fluids to avoid dehydration. You will need to troubleshoot the pump to look for reasons why you are not getting the insulin. The presence of ketones means insulin has not been delivered for several hours.