Insulin Pumps: If a child uses an insulin pump device and requires admission to hospital, it is hoped in most cases that they may be able to remain on their insulin pump for the duration of their stay. This is on the understanding, however, that an appropriately-trained adult is able to remain with them at all times and takes full responsibility for use of the insulin pump. Ward nursing staff are not trained in how to use any of the pump devices provided by NHS GGC. Should an adult be unable to remain with the child, or their condition warrants the removal of the pump, then they should either return to injection therapy or be commenced on an IV insulin infusion.
Converting from Pump Settings to Insulin Injections: 1. Calculate the average Total Daily Dose (TDD) of insulin for at least the last 3 days before the day of change. 2. Give 20% of the TDD as a Levemir injection every 10-12 hours. 3. Give 20% of the TDD as NovoRapid (or other rapid-acting insulin) before main meals or use the Carb Ratios from the pump settings with the main meals. 4. Correction doses of NovoRapid (or other rapid-acting insulin) may be given in addition to Point 3 above, and may be repeated every 4 hours if required.
Insulin Pump Therapy Guideline: This guideline provides much more detail on insulin pump therapy in hospital. (Note that it was updated in 2014 so the guidance on changing to injection therapy differs from that above and the insulin pumps described are old models and no longer in common use)
Glucose Monitoring in Hospital: It may be that a child attends hospital wearing a glucose monitor that reads the interstitial glucose rather than the blood. This could be a Continuous Glucose Monitor or a device like a FreeStyle Libre. Although they may continue to wear these devices in hospital (where their condition permits) the results obtained from them should not be used to guide clinical decisions. Interstitial glucose can differ from blood glucose and so only blood glucose measurements should be used to guide treatment in hospital.