What to do when blood glucose is high

This insulin pump troubleshooting protocol will guide you through the process of managing an unexpectedly high blood glucose event.

High blood glucose while on an insulin pump

  • Keep your pump settings (provided to you at every visit) and these instructions in your meter case for emergency reference.
  • If your pump malfunctions, you will not be able to retrieve your insulin rates, carb ratios, correction/sensitivity factor or target glucose value. These will be needed to return to injections if necessary. 

Step 1. Check pump to see if last meal bolus was given; if not, give correction and recheck blood glucose in two hours.  If not changed in two hours or if blood glucose is higher, follow Step 2

Step 2. If yes, take correction according to pump calculation by injection.

  1. Change infusion set/pod
  2. Drink water
  3. If possible, don’t eat until glucose is in the 200’s
  4. Do not exercise

If at night, set alarm and check blood glucose in 3-4 hours; correct according to your active insulin/insulin on board time if needed.

Remember, your pump does not know you took an injection.  Wait 3-4 hours before re-correcting.  Determine correction based on blood glucose minus blood glucose target equals difference divided by sensitivity/correction.

Process of switching from insulin pump to injections

Occasionally, it may be necessary to discontinue insulin pump use and take insulin injections.  The most common reason for this is if your pump suddenly needs to be replaced and you are awaiting the arrival of a loaner pump (1-2 days).  Since you should always carry your insulin and syringe with you, you should begin taking the same amount and type of insulin by syringe that your pump would be giving you, every 3-4 hours (duration of action for Humalog, Apidra, and Novolog) around the clock, including the middle of the night.

If you are unable to find your rates in your insulin pump use the most recent pump settings that were provided to you at your last provider appointment.

Follow these guidelines:

  1. Check your glucose every 3-4 hours.
  2. Calculate the insulin you will need for the next 3-4 hours:
  • Bolus for the meal
  • Correction insulin for high blood glucose every 4 hours if necessary
  • Basal insulin for the next 3-4 hours
  1. Add together and round up or down based on whether you expect to need more or less insulin, e.g., eating out = round up; increased activity = round down.
  2. Monitor glucose again in 3-4 hours and repeat the same process until you are back on the insulin pump (resume the pump 3-4 hours after your last insulin injection).


The opinions expressed here represent the views of a practicing hormone specialist (endocrinologist) and must not substitute the advice of your health care provider. This blog post is written for a non-medical audience interested in learning more about hormonal disorders. The author has no commercial conflicts of interest to declare. Also, read our privacy policy.

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About the Author MyEndoConsult

The MyEndoconsult Team. A group of physicians dedicated to endocrinology and internal medicine education.

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