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 infusion set/ damp adhesive/ air in tube/ no insulin left in pump. If so, proceed to ‘CHANGE’.
Is the pump running? Is there battery loss? Check the pump 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 T:Slim, 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 T:Slim 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 set change (new insulin, cartridge, tubing AND infusion set).
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.
|
Blood ketones 0.0-0.6mmol/L |
Blood ketones 0.7-1.5mmol/L |
Blood ketones 1.6mmol/L and above |
|---|---|---|
|
Blood ketones 0.0-0.6mmol/L · Follow hyperglycaemia pathway ABCC: - Assess obvious reason for high levels - Bolus a correction dose - Check levels after one hour - Change infusion set if levels have not dropped by 2mmol/L · Start temporary basal rate of 125% for 2 hours · Check blood glucose and blood ketones 1-2 hourly |
Blood ketones 0.7-1.5mmol/L · Give 10% Total Daily Dose* and normal correction using a RAPID ACTING INSULIN PEN · Change infusion set and insulin in pump. · Start temporary basal rate of 150% on pump · Check blood glucose and blood ketones 1-2 hourly |
Blood ketones 1.6mmol/L and above · Give 20% Total Daily Dose* and normal correction using a RAPID ACTING INSULIN PEN · Change infusion set and insulin in pump · Start temporary basal rate of 175% on pump · Check blood glucose and blood ketones 1-2 hourly |
|
Blood ketones 0.0-0.6mmol/L Repeat above steps every 2 hours until… |
Blood ketones 0.7-1.5mmol/L Repeat above steps every 2 hours until… |
Blood ketones 1.6mmol/L and above Repeat above steps every 2 hours until… |
|
Blood ketones 0.0-0.6mmol/L · When blood glucose has been below 14mmol/L for 4 hours, stop temporary basal rate · If blood glucose does not improve, increase temporary basal rate to 150% · If blood ketones increase to 0.7-1.5mmol/L; follow advice in 2nd column (0.7-1.5mmol/L) · If blood ketones increase to 1.6mmol/L and above; follow advice in 3rd column (1.6mmol/L and above) |
Blood ketones 0.7-1.5mmol/L · When blood glucose is below 14mmol/L and blood ketones 0.0-0.6mmol/L; reduce temporary basal rate to 125% on pump · When blood glucose has been below 14mmol/L for 4 hours, stop temporary basal rate · If blood glucose or ketones do not improve, increase temporary basal rate to 175% · If blood ketones increase to 1.6mmol/Lor above; follow advice in 3rd column (1.6mmol/L and above) |
Blood ketones 1.6mmol/L and above · When blood glucose is below 14mmol/L and blood ketones 0.0-0.6mmol/L; reduce temporary basal rate to 125% on pump · When blood glucose has been below 14mmol/L for 4 hours, stop temporary basal rate · If blood ketones continue to rise, increase temporary basal rate to 200% |
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.
|
Blood ketones 0.0-0.6mmol/L |
Blood ketones 0.7-1.5mmol/L |
Blood ketones 1.6mmol/L and above |
|---|---|---|
|
Blood ketones 0.0-0.6mmol/L For BG less than 5mmol/L: · Start temporary basal rate of 50% for 2 hours · Encourage carbohydrate containing food or fluid (as tolerated) without insulin · Check blood glucose and blood ketones 1-2 hourly For BG above 5mmol/L: · No temporary basal rate · Check blood glucose and blood ketones 1-2 hourly · Encourage carbohydrate containing food or fluid (as tolerated) with insulin |
Blood ketones 0.7-1.5mmol/L For BG less than 5mmol/L: · Start temporary basal rate of 75% for 2 hours · Encourage carbohydrate containing food or fluid (as tolerated) with insulin · Check blood glucose and blood ketones 1-2 hourly For BG above 5mmol/L: · No temporary basal rate · Encourage small amounts of carbohydrate with insulin · Give correction bolus if suggested by pump · Check blood glucose and blood ketones 1-2 hourly |
Blood ketones 1.6mmol/L and above For BG less than 5mmol/L: · No temporary basal rate · Encourage carbohydrate containing food or fluid (as tolerated) with insulin · Check blood glucose and blood ketones 1-2 hourly For BG above 5mmol/L: · No temporary basal rate · Encourage small amounts of carbohydrates with insulin · Give correction bolus if suggested by pump · Add 5% of Total Daily Dose* to any bolus you give · Check blood glucose and blood ketones 1-2 hourly |
|
Blood ketones 0.0-0.6mmol/L Repeat above steps every 2 hours until… |
Blood ketones 0.7-1.5mmol/L Repeat above steps every 2 hours until… |
Blood ketones 1.6mmol/L and above Repeat above steps every 2 hours until… |
|
Blood ketones 0.0-0.6mmol/L · Continue with above until blood glucose remains above 5mmol/L for at least 4 hours · If blood ketones increase to 0.7-1.5mmol/L: follow advice in 2nd column (0.7-1.5mmol/L) · If blood ketones increase to 1.6mmol/L or above; follow advice in 3rd column (1.6mmol/L and above) |
Blood ketones 0.7-1.5mmol/L · Continue with above until blood glucose remains above 5mmol/L and blood ketones 0.0-0.6mmol/L for 4 hours · If blood ketones increase to 1.6mmol/L or above; follow advice in 3rd column (1.6mmol/L and above) |
Blood ketones 1.6mmol/L and above · Continue with above until blood glucose remains above 5mmol/L and blood ketones 0.0-0.6mmol/L for 4 hours · If you are concerned please call diabetes team for advice · If your child becomes seriously unwell, go to the nearest A+E immediately |
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.
- Treat hypoglycaemia with glucose gel as that is absorbed in the cheek not stomach.
| High glucose and/or ketone levels | Being very thirsty |
| Needing to urinate more frequently | Feeling very tired/sleepy |
| Being drowsy or passing out | Stomach pain |
| Feeling sick or vomiting | Sweet fruity smelling breath |
| Headache or blurred vision | Deep or fast breathing |
| Confusion |
*Finding the Total Daily Dose on the Tandem T:Slim pump:
Options > History > Pump History > Delivery Summary > 14 Day Average.
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