High or low blood glucose using the Ypsopump during pregnancy

You have this leaflet because you use the Ypsopump to manage your diabetes. This pump is a hybrid closed loop system. A hybrid closed loop system is a set of small devices that help people with Type 1 diabetes manage their blood sugar.

The pump has:

• a sensor that checks sugar levels all the time; and

• an insulin pump that gives insulin when it is needed.

A computer programme connects them, and can change how much insulin is given to help keep blood sugar in a safe range.

It is called “hybrid” because it works partly on its own. However, the person still needs to tell it when they eat and check it now and then.

This leaflet will help you to manage sick days and unexplained high blood glucose (sugar). It explains:

• why high sugar levels can happen;

• how to check for ketones; and

• the steps to take to reduce the risk of diabetic ketoacidosis (DKA).

This leaflet will help you to know when to ask for urgent medical advice. If you have any questions or concerns, please speak with your diabetes team, midwife, or doctor.

Why is my blood sugar high even with the YpsoPump?

Your blood sugar can be high when your body does not respond as it should to insulin delivered through the pump. If this happens during pregnancy, you must contact Maternity Triage immediately.

• Maternity Triage
  Telephone: 01227 206737
  Open: 24 hours a day, 7 days a week

Delays in treatment can increase your risk of diabetic ketoacidosis (DKA). This is a serious condition caused by a lack of insulin. More information is available below.

People using a hybrid closed loop system (such as the YpsoPump) rely on continuous insulin delivery. If insulin is not absorbed properly, glucose levels can rise quickly even if the pump appears to be working.

The following are common causes for high blood sugar levels

• A bent or blocked cannula

• Infusion set failure

• Air bubbles or leakage in the tubing to the pump

• Illness or infection

• Increased insulin needs during pregnancy

If untreated, the body begins to break down fat for energy. This causes the body to produce ketones. High ketone levels can make you seriously unwell and need emergency care.

During pregnancy, diabetic ketoacidosis can develop more quickly. It can be a serious risk to both you and your baby. It can cause your baby to become distressed, and also has the possibility of pregnancy loss. Quick action when blood glucose is high is essential to protect both your health and your baby’s wellbeing.

What is Diabetic Ketoacidosis (DKA)?

DKA is a serious and potentially life-threatening complication of diabetes. It occurs when the body does not have enough insulin. Without enough insulin, glucose cannot enter the body’s cells to be used for energy. The body then begins to break down fat instead, producing acids called ketones.

As ketones build up in the bloodstream, the blood becomes more acidic, this can make you very unwell. Symptoms often include:

• excessive thirst

• passing urine (wee) more frequently

• nausea (feeling sick)

• vomiting (being sick)

• abdominal (tummy) pain

• fast or deep breathing

• feeling very tired

During pregnancy, DKA can develop more quickly and at lower glucose levels. This can increase the risk of harm to both you and your baby. DKA is a medical emergency that needs urgent hospital treatment.

How does an insulin pump work?

An insulin pump delivers fast-acting insulin through a small soft tube (a cannula) in your arm or tummy. The cannula is placed under the skin. This provides you with a continuous supply of insulin. It will also give you extra doses when needed.

If you are using a hybrid closed loop system, the pump sends messages to your phone by Bluetooth. This allows it to automatically adjust the insulin delivery and keep your sugar levels within range.

This only works when the pump and your phone remain connected. If the Bluetooth connection is lost, the pump cannot change the amount of insulin it delivers. Your pump will then only continue to deliver insulin using its pre-set rates. You will not receive updated corrections by Bluetooth. It is important to check that your pump and phone are always connected. This is most important if your sugar levels begin to rise.

Insulin may not enter your body properly if the cannula (soft plastic tube) bends or becomes blocked. The pump may still show you that insulin has been delivered, even thought it was not delivered properly. This can delay you realising there is a problem. For this reason, high sugar (glucose) that is not improving must always be checked quickly.

Why was it recommended that I use the Ypsopump?

Ypsopump is a hybrid closed loop system. These pumps work very well for day-to-day glucose management. However, no insulin pump can correct a mechanical problem. Mechanical problems include a blocked or bent cannula.

If glucose levels are not improving, give insulin by pen or syringe, and change the infusion set. This will make sure that insulin is delivered and reduces the risk of complications.

What should I do if I feel unwell at home?

If you feel unwell, act quickly. During pregnancy, high blood glucose can worsen more quickly, early action is important.

Contact your Diabetes team or Maternity Triage for advice if:

• you are unsure what to do; or

• if your readings are not improving.

The Diabetes team and Maternity Triage contact details are at the end of this leaflet.

If you need urgent care, attend your nearest Emergency Department without delay.

What should I do if my blood glucose stays high?

Your pump may not be working, even if it looks like it is. If your glucose stays high, insulin from the pump may not be entering your body.

The most common reason is a bent or kinked cannula. This can happen without pain and without obvious signs and the skin may look normal.

When a cannula is bent

• The pump still looks like it is delivering insulin

• The pump may show insulin on board

• However, little or no insulin is absorbed by your body

Because the pump thinks that insulin is still being delivered

• The correction doses become smaller

• Repeated pump corrections will not work

• Ketones may stay the same or rise, as no insulin is being delivered

What to do

• Give the pump one chance

• Give one correction through the pump

• If glucose or ketones do not improve, use a pen or syringe

• Change the full infusion set immediately (cannula, infusion line. and reservoir)

Using a pen ensures insulin is delivered properly. Changing the full infusion set removes the cause of the problem.

If your blood glucose is above 10 mmol/L

If your blood glucose is above 10 mmol/L and:

• not falling; or

• you feel unwell

You must do the following.

• Check blood ketones and follow the thresholds below

• Check finger-prick glucose matches sensor glucose

• Inspect your infusion site and pump

Blood ketone thresholds used in this leaflet

• 0.0 to 0.5 mmol/L: Low ketones

  Continue to monitor. Contact the Diabetes team if ketones do not resolve or get worse.

• 0.6 to 1.0 mmol/L: Moderate ketones

  Urgent advice needed from the Diabetes team. Out of hours contact Maternity Triage.

• 1.1 to 1.9 mmol/L: High ketones

  Prepare to go to hospital.

• 2.0 mmol/L or above: Very high ketones

  Must go to hospital immediately. Please do not drive yourself to hospital, ask someone to take you.

0.0 to 0.5 mmol/L: Low ketones

• Actions

  • Give one correction using pump

  • Use Boost if glucose is rising

  • Inspect infusion site and pump if glucose is not falling

  • Give correction dose by pen or syringe

  • Change full infusion set (cannula, line, reservoir)

  • Continue pump use after set change

  • Drink sugar-free fluids

• Monitoring

  • Check glucose and ketones every 2 hours

• Escalation

  • Contact Diabetes team if ketones do not resolve or get worse

0.6 to 1.0 mmol/L: Moderate ketones

• Actions

  • Give one correction via pump

  • If no improvement, give pen correction and change infusion set

  • Remain in closed loop mode after set change

  • Use Boost

  • Drink at least 100 ml of sugar-free fluid per hour

  • Avoid strenuous exercise

• Monitoring

  • Check glucose and ketones every 2 hours

• Escalation

  • Ask for urgent advice if no improvement within 2 hours

1.1 to 1.9 mmol/L: High ketones

• Actions

  • Change cannula, infusion set, and reservoir

  • Give 10% of total daily dose (TDD) by pen or syringe

  • Use Boost once new set in place

  • Drink at least 100 ml sugar-free fluid per hour

  • Avoid strenuous exercise

• Monitoring

  • Check glucose and ketones every hour

• Escalation

  • Prepare to go to hospital if no improvement after 2 hours or if feeling unwell

2.0 or above mmol/L: Very high ketones

• Action

  • Change cannula, infusion set, and reservoir

  • Give 20% of TDD by pen or syringe

  • Use Boost once new set is in place

  • If able, continue sipping sugar-free fluids

  • Go to your nearest hospital Emergency Department immediately. Do not delay.

• Monitoring 

  • The hospital will monitor you each hour

• Escalation

  • Go to your nearest hospital Emergency Department immediately. Do not delay.

What if I am being sick and cannot keep any fluids down?

You must go to your nearest Emergency Department urgently if you are:

• vomiting

• unable to keep fluids (drinks) down

• unable to control blood glucose or ketones

How do I use insulin when I am unwell?

When glucose levels are rising during illness:

• use the Boost function to increase insulin delivery;

• give correction doses as advised; and

• if ketones are present, follow the ketone guidance above.

DKA safety checklist

Make sure you always have access to the following items.

• Blood glucose, ketone meter, and in-date strips

• Rapid-acting insulin pen or syringe

• Long-acting insulin pen or syringe

• A copy of this leaflet

• Your total daily dose (TDD) written down

The Diabetes team should review your manual basal rates regularly (every 2 to 4 weeks). If they have not been reviewed in this time, contact your Diabetes team.

Travel checklist

Before travelling make sure you have the following items.

• Medical letter confirming pump and CGM use

• Extra insulin, cannulas, and infusion sets

• Long-acting insulin and pens or syringes

• Blood glucose, ketone meter, and in-date strips

• A copy of this leaflet

• Hypoglycaemia treatment

• Sharps disposal method

• Emergency contact numbers

What if my blood sugars become too low? Treating mild hypoglycaemia (Hypo)

• Hypoglycaemia is when glucose levels fall below 4 mmol/L. If your glucose levels are close to this level it is likely that your hybrid closed-loop system has not delivered any insulin for some time. This means that less rapid-acting carbohydrate can be used to prevent hypoglycaemia. For example:

  • 4 to 5g of rapid acting carbohydrate if your glucose is between 4.0 and 6.0 mmol/L with a down (↓) trend arrow.

  • Treat mild hypoglycaemia with 8 to 10g of rapid acting carbohydrate if glucose is less than 4 mmol/L.

• Hypo treatment always needs to be entered into the pump, However, we do not give any extra insulin for this. Instead we use the “add meal function” on the pump. To do this you will need to follow the steps below.

  • Access the menu in the top left-hand corner of the CamAPS FX phone app.

  • Click 'add meal'.

  • Enter the carbohydrates taken to treat the hypoglycaemia.

  • Tick hypoglycaemia treatment.

  • Click continue.

  • Click confirm. 

• Avoid overtreatment (taking too much glucose) where possible. This can lead to rebound high glucose levels.

• If you choose to have second line treatment this must be entered into your pump in the normal way. Second line treatment would include biscuits / your next meal if it is due.  This will mean you will receive insulin to cover the carbohydrates that you have eaten.

What are the symptoms of severe hypoglycaemia?

During pregnancy, severe hypoglycaemia can occur.

Early symptoms

• Shaking or trembling

• Sweating

• Hunger

• Dizziness or light-headedness

• Palpitations (fast heartbeat)

• Anxiety, nervousness, or irritability

• Tingling around the lips or fingers

More severe symptoms

• Difficulty concentrating

• Confusion or unusual behaviour

• Blurred vision

• Slurred speech

• Weakness or fatigue (feeling very tired)

• Lack of coordination

• Headache

Severe hypoglycaemia (medical emergency)

• Seizures (fits)

• Loss of consciousness

• Coma

How is severe hypoglycaemia treated?

• Carry glucagon at all times.

• Make sure at least one person close to you (partner, family member, friend or colleague) knows:

  • where your glucagon is kept;

  • how to recognise severe hypoglycaemia; and

  • how to administer glucagon.

• Glucagon should be used if you are:

  • unconscious

  • having a seizure

  • unable to take glucose by mouth safely

• After glucagon is given:

  • contact 999 and ask for an ambulance

  • you must be reviewed by a healthcare professional

Contact your Diabetes team for replacement and / or training if:

• your glucagon is out of date; or

• you have not been shown how to use it.

What will happen if I refuse treatment?

You have the right to refuse any treatment. It is important to understand the risks of leaving high blood glucose untreated.

Without effective insulin delivery

• Blood glucose levels are likely to continue rising.

• Ketones may develop or increase.

• You may become dehydrated and unwell.

• The risk of diabetic ketoacidosis (DKA) increases.

DKA is a medical emergency that needs urgent hospital treatment. During pregnancy, it can become serious more quickly and may affect both you and your baby.

If a healthcare professional recommends one or more of the following and you refuse, it could delay treatment and increase your risk or complications.

• Hospital assessment.

• Insulin injections.

• An infusion set change when they are recommended.

What happens if the condition is left untreated?

If sustained high glucose and rising ketones are not treated, you could experience one or more of the following.

• Symptoms such as nausea, vomiting, abdominal pain, and extreme tiredness can occur.

• Breathing may become faster or deeper.

• Hospital admission is very likely to be needed.

• In severe cases, DKA can be life-threatening to both you and your baby.

• It may also increase the risk of complications. These may include foetal distress, premature birth, or pregnancy loss. In rare cases it may affect your baby's development.

Early treatment greatly reduces these risks. It is usually effective in stabilising your condition.

Even if you decide not to proceed with the recommended treatment straight away, you should seek urgent medical advice if:

• your glucose remains high;

• your ketones rise; or

• you feel unwell.

Your healthcare team is available to:

• explain the benefits and risks of each option; and

• support you in making a decision that aligns with your values and clinical needs.

Shared decision making

We encourage you to be actively involved in decisions about your care. Shared decision-making means working in partnership with your healthcare team to choose the treatment that is most appropriate for your clinical needs, preferences, and circumstances.

You may wish to understand:

• how well a treatment is likely to work;

• whether there are alternative approaches; and

• what could happen without treatment.

Taking time to gather information can help you feel more confident in the decisions you make.

• Ask questions about the benefits and risks of each option.

• Discuss any worries or practical concerns you may have.

• Consider how treatment might affect your daily life.

• Write down questions before appointments, so you do not forget them.

• Ask for information to be explained again if anything is unclear.

If you have a partner, family member, or carer, you may find it reassuring to involve them in discussions. They can support you in understanding your options and help you remember the information you are given.

Your healthcare team will explain their recommendations and the reasons for them. You are encouraged to share what matters most to you, so that decisions reflect both clinical safety and your personal priorities.

Even when a treatment is strongly advised, your consent is needed before it goes ahead. You have the right to take time to think about your options and ask further questions before making a decision.

If you feel unsure at any stage, let a member of the team know. Their role is to support you in making an informed choice that you are comfortable with.

Useful contacts

• Contact Maternity Triage on 01227 206737 for help and advice. They are available 24 hours every day.

• Contact the Diabetes Antenatal Nursing team on 01843 234261 or email. They are available during office hours 8am to 4pm, Monday to Friday.

References

• Association of British Clinical Diabetologists (ABDC). The ABCD Diabetes Technology Network (ABCD-DTN). Best practice guide for hybrid closed- loop therapy.

• Association of British Clinical Diabetologists (ABCD). Hybrid closed loop (HCL) system: information leaflet.

• National Institute for Health and Care Excellence (NICE). Diabetes in pregnancy: management from preconception to the postnatal period (NG3). Published 25 February 2015. Last updated 16 December 2020. 

• Joint British Diabetes Societies for Inpatient Care (JBDS-IP). The management of diabetic ketoacidosis in adults. Revised March 2023.

[Web sites last accessed 9 June 2026]

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