Insulin pump Sick Day Rules for Omnipod5 SmartAdjust - Information for children/young people and parents/carers

The ABCC rule should be followed when blood glucose are above 14 mmol/L and there are no signs of significant illness or raised ketones.

The ABCC rule should be stopped and Sick Day Rules commenced if blood ketones levels reach 0.7 mmol/L or higher, or if they are unwell.

ABCC rule – follow when glucose above 14mmol/L and feeling well

ASSESS

Assess any obvious reason for hyperglycaemia: Is there insulin delivery problem eg. Dislodged Pod/ damp adhesive/ no insulin left in pump. If so, proceed to ‘CHANGE’.

Is the pump running? Check the Controller for any alerts or alarms and troubleshoot accordingly.

If you have eaten and bolused recently, wait until it has been two hours since that bolus then check again (ie. Follow the “2 hour correction rule”).

If no clear reason for hyperglycaemia, proceed to next step.

BOLUS

Give a correction bolus of insulin, via the Controller, using the bolus calculator.

CHECK in one hour

Check glucose level one hour after this bolus was given.

If glucose has dropped by at least 2mmol/L then insulin delivery is working. Continue to check glucose two hourly and give corrections as needed.

If glucose is within 2mmol/L of previous glucose or has risen: proceed to next step.

CHANGE

There is a problem with insulin delivery.

Use the bolus calculator in the Controller to calculate a correction dose of rapid-acting insulin and give by pen injection. (Or manually calculate dose using current insulin correction factor).

Complete a Pod change (new insulin AND Pod).

Continue to follow ABCC and check glucose regularly. Check blood ketones if glucose has been above 14mmol/L for two hours.

If glucose levels have still not improved despite following the above steps OR your child starts to show signs and symptoms of DKA, please check ketones:

• If ketones 0.0-0.6mmol/L, repeat ABCC rule steps.
• If ketones 0.7mmol/L or above, follow Sick Day Rules instead and stop following the ABCC rule.

Please contact the diabetes team should you have any concerns.

Key points:

• If you are concerned, please contact your diabetes team or Out Of Hours for help.
• If your child becomes seriously unwell or shows signs of DKA, go to the nearest A+E.
• Encourage your child to drink plenty of sugar-free fluids, remember this flushes out ketones. The extra insulin stops more ketones being created.
• If unable to eat, take small amounts of carbohydrate-containing fluid often to prevent starvation ketones.

Insulin corrections should only be given every two hours, not more frequently.

Key points:

• If you are concerned, please contact your diabetes team or Out Of Hours for help.
• If your child becomes seriously unwell or shows signs of DKA, go to the nearest A+E.
• Encourage your child to drink plenty of sugar-free fluids, remember this flushes out ketones.
• If unable to eat, take small amounts of carbohydrate-containing fluid often to prevent starvation ketones. Starvation ketones are treated with normal insulin and normal carbohydrates.

Treat hypoglycaemia with glucose gel as that is absorbed in cheek not stomach.

*Finding the Total Daily Dose on the Omnipod 5 pump:

Menu > History Detail > Under ‘Insulin & Carbs’ should display ‘Total Insulin’ > Add up past seven days of ‘Total Insulin’ > Then divide by seven: answer is total daily dose

Alternatively, look on Glooko for 14 day average of total daily dose.

Out of Hours phone number:

• 01438 285000

This is a regional service which diabetes teams rotate cover for. You will be required to supply your phone number and your child’s name to the operator. This will be passed on and the diabetes practitioner on call will phone you back to give advice.