Adjusting Insulin During Illness (Pump)

T1D & Illness: how to adjust pump insulin when your child is sick

Managing your child’s diabetes when he is sick is challenging. Sometimes the usual insulin doses need to be altered during illness to avoid lows and highs. Here are specific tips for pump users on when and how much to adjust insulin during these times.

Also see the 10 Safety Rules for Managing Diabetes When Your Child is Ill,  .

For Injections see instead:

If blood glucose is less than 14.0 mmol/L or the ketones are negative:

The usual correction may be used, and may be delivered through the pump.

If blood glucose is 14.0 mmol/L or higher, AND blood ketones are 0.6 mmol/L or higher (or urine ketones are positive):

  • It's wise to give your child a correction by injection (pen or syringe) right away.

  • When ketones are positive, your child may need at least 50% more correction insulin than normal.

You can use one of the following methods to calculate the approximate amount of extra insulin:

(both yield the same result)

Method A: Use the Pump Bolus Calculator

Give a correction that is 50% more than what your bolus calculator recommends.

For example, if it recommends 6.4 units, give 3.2 units more, for a total of 9.6 units. Round off and give 10 units by injection.

Method B: Use a correction formula to calculate the dose:

(current blood glucose) – (target blood glucose)   X  1.5

Insulin sensitivity factor

For example, if the blood glucose is 22.8, ketones are ++, insulin sensitivity factor is 3, and the target blood glucose is 7…

(22.8 – 7)  X  1.5  = 7.9


Round off and give 8 units by injection.

  • After giving the insulin by injection, it may be wise to change the infusion set. Keep correcting high blood glucose every 2 – 3 hours.


If your child has an illness that results in ongoing high blood glucose, you may choose to increase the basal rate.

  • It may be helpful to set a temporary basal rate of 20-50% more for 4 hours, then reassess.
  • If the blood glucose is still high, you may want to increase the basal rate by another 20-50% for 4 hours.
  • Always reassess the basal rate every 4 hours.

If your child’s illness has resulted in low blood glucose (less than 4.0 mmol/L):

  • Treat the low, consider suspending the pump for 1 hour, then reassess.
  • When the blood glucose is 6.0 mmol/L or more, you may restart the pump with a decreased basal rate. Setting a temporary basal rate of 50% less for 4 hours and then reassessing may be helpful.
  • You may choose not to bolus for foods or fluids until the blood glucose is 10.0 mmol/L or more.


  • The above information was adapted with permission from The Alberta Children’s Hospital Diabetes Clinic information handouts.

    The above information was reviewed for content accuracy by clinical staff of the Alberta Children’s Hospital Diabetes Clinic.