Ketones and Insulin Pumps

There is a higher risk for developing ketones on pump therapy. This is because long-acting insulins are not used, and rapid-acting insulin is delivered in extremely small amounts. If this basal insulin delivery is interrupted for more than an hour, check your blood glucose and ketones. If you continue to not get insulin, blood glucose and ketone levels may increase into a dangerous range. See also Acute: Diabetic ketoacidosis (DKA).

Insulin pump-related ketone buildup may be caused by:

  • Infusion set problem (See Tips on infusion sets and sites)
  • Site problem
  • Air in tubing (resulting in missed insulin)
  • Extended pump suspension or disconnection (for more than one to two hours)
  • Pump malfunction
  • Insulin leakage (at insertion site or infusion set connection site)
  • Illness or infection
  • Vomiting or dehydration
  • Severe emotional stress
  • “Spoiled” insulin

Ketones checklist

The presence of ketones while using an insulin pump can indicate a serious medical emergency.

Check for ketones if you have:

  • An unexplained elevation in your blood glucose
  • Persistently elevated blood glucose levels
  • Symptoms of nausea or vomiting

This is because you want to be sure you are not developing diabetic ketoacidosis. Remember that ketoacidosis occurs more commonly in pump users. Here’s what you should do. Use the mnemonic KISS.

K – Check for Ketones
I – Give Insulin by Injection (using an insulin pen or syringe - not through the pump)
S – Change the infusion Set
S – Check blood Sugar (glucose)

If ketones are 'moderate' with symptom or 'large', you need to contact your Health Care Provider immediately.

Treating ketones

If you have elevated ketones, insulin replacement must be delivered via an injection with an insulin pen or insulin syringe instead of the pump because the pump or infusion set may be malfunctioning and causing ketones to develop.

Remember! Ketoacidosis is a medical emergency that requires immediate medical attention. Always carry an insulin vial and syringe or an insulin pen with needle for backup. Speak with your doctor and have a backup plan in case of pump malfunction.