INSULIN PUMP THERAPY

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1 INSULIN PUMP THERAPY Information Leaflet Your Health. Our Priority.

2 Page 2 of 5 Insulin management plan for pregnant women using insulin pump therapy If at any point, you are not able to control your blood glucose levels adequately (between mmol/l), pump therapy may have to be discontinued and an intravenous insulin infusion used for the safety of your baby. Antenatal care During the antenatal period the Diabetes Team will advise you regarding the changes to your insulin pump regimen. If you are admitted to hospital during the pregnancy you can continue to use the pump so long as you are able to manage it and can perform the required blood glucose testing. Steroids during antenatal period Increase the basal rate by 50% when commencing steroid treatment. The basal rate can be increased or reduced in 10% increments if required, using the temporary basal rate. Correction bolus doses may be given at hourly intervals. Calculate the correction dose to assume that 1 unit of insulin will reduce the blood glucose by 2.5 mmol/l. Bolus doses may need to be increased as well. Labour and delivery During induction of labour you can continue using the pump so long as blood glucose levels stay between 4.0 and 8.0 mmol/l. During induction you will be able to have a light diet. During this period, avoid using the dual wave or extended bolus features on your pump. For insulin doses of 5 units or more, the dose should be split in 2 halves. One half should be taken before eating and the second half when you have finished eating. Once in established labour, the midwife will commence an intravenous variable rate insulin infusion and when this is running you will be asked to stop the pump and remove the cannula. After delivery or caesarean section As soon as you are able to eat and drink normally the midwife will ask you to re-site your pump cannula and after it has been running for 1 hour, the insulin infusion will be discontinued.

3 Page 3 of 5 The body s demand for insulin in the first 24 hours after delivery usually reduces. Therefore, your basal rate should be at your pre-pregnancy rate minus 10% and be reassessed within the initial 24 period. Return to using your normal insulin/carbohydrate ratio (e.g. 1 unit of insulin per 10g of carbohydrate). You can now use the dual wave or extended features on your pump. Breast-feeding If breast-feeding, the basal rate may need reducing by a further 10-20% of your already reduced pre-pregnancy rate. The insulin to carbohydrate ratio should be adjusted back to pre-pregnancy ratio (e.g. 1 unit of insulin to 10g carbohydrate). If for any reason you have to discontinue insulin pump therapy and go back to a basal bolus regime, the formula below is a guide to calculating your basal bolus doses. Changing back to a basal bolus regimen from using pump therapy Estimate your average Total Daily Dose (TDD) of insulin. Your Pump can tell you the TDD for a number of days previously. Add 10% to this total. e.g. 40 units per day + 10% 40 x 10 = Therefore, = 44 units Approximately, one third of this total should be your long acting insulin and the remainder divided up to give 3 meal doses of rapid acting insulin. e.g = Therefore, take 15 units of long acting insulin. 29 units are remaining = 9.66 units Therefore, approximately 10 units of rapid acting insulin should be taken with each meal. Supervisors of midwives Need extra information, support or advice? Contact a supervisor of midwives by ringing the main switchboard at Stepping Hill Hospital: A supervisor of midwives is available 24 hours a day.

4 Page 4 of 5 Supervisors are concerned with ensuring the safety and well-being of mother and baby and with the provision of high quality midwifery care. Contact us Antenatal Clinic Diabetes Specialist Midwife Triage Department

5 Page 5 of 5 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number MAT127 Publication date April 2014 Review date April 2017 Department Antenatal Clinic Location Women s Unit, Stepping Hill Hospital