Causes and Prevention of Hypogycemia with Pump Therapy with Pump Therapy
Inappropiate target blood glucose levels.
Set target blood glucose ranges higher for pump users with a history of hypoglycemia or reduced hypoglycemia awareness.
Basal rate set too high.
Confirm appropriateness of basal rate(s). If hypoglycemia occurs when meals are delayed, an adjustment in basal rate is needed. Periodically measure blood glucose at 3 a.m. to determine whether overnight basal rate needs to be reduced.
Taking too large a bolus for the carbohydrate content of a meal.
Provide specific, individualizad guidelines for mealrelated boluses with extreme caution after unusually intense or prolonged excercise.
Not compensating for exercise by making appropriate adjustments in insulin dose and/or food intake. Unusually long or intense exercise can cause delayed (post-exercise) hypoglycemia.
Instruct pump users to compensate for exercise with appropriate decreases in basal or bolus insulin doses or increased carbohydrate intake. Administer bedtime boluses with extreme caution after unusually intense or prolonged exercise.
Excessive bolusing to correct hyperglycemia.
Provide specific, individualizaed guidelines for supplemental insulin doses (refer to the "1500 rule"). Before bolusing, pump user may use pump memory feature to review all boluses given in the previous 5 hours.
Insufficient frequency of blood glucose monitoring.
Instruct pump users to monitor at least 4 times a day, including bedtime. Less frequent monitoring does not allow prompt enough response to an out-of-range level.
Warm pump users about the hypoglycemic effect of alcohol. Individuals should aminister bedtime boluses with extreme caution after drinking alcohol.