University College Hospital

Correcting high blood glucose

levels
Children & Young People’s Diabetes Service
Why do I need to treat high blood glucose levels?
If you do not treat a high blood glucose level with additional insulin, you may stay
high for many hours. This might make you feel unwell in the short term but if it
happens frequently, this can overtime contribute to worsening your HbA1c.

What should my blood glucose level be?

The broad range for blood glucose level is between 3.6mmol/L and 9mmol/L. The
targets are the same for everyone, regardless of age or what insulin regimen you
use.

We recommend aiming for a normal blood glucose level, this means:

 Waking (fasting) and pre meal blood glucose levels should be between 3.6
and 6.9mmol/L
 After meals/food (2-3 hours later) blood glucose levels should be below
9mmol/L
 Before physical activity and exercise, blood glucose levels should be between
5 and 7mmol/L

In addition, you should check for blood ketones when the blood glucose level is
above 14 mmols/L.

Please see table below for blood glucose levels and the relevant action and
treatment advice, recommended by the UCLH team.
BG level Treatment advice Insulin
mmol/L

Less than BG too low Treat with glucose Check Blood Glucose 15 minutes after
3.6 (Hypoglycaemia) (2-15 grams hypo treatment
depending on age
of child) If hypo just before starting a meal, delay
giving insulin bolus for meal until after
See eating meal.
‘hypoglycaemia’
leaflet
3.6 – 3.9 BG level at low If showing If about to eat a meal/snack and using a
end of target symptoms of or pump/meter bolus calculator, the dose of
range feeling insulin will be automatically reduced to
hypoglycaemia, or bring BG up to middle of target range
BG dropping quickly
treat as if hypo
4.0-6.9 BG level in target N/A If about to eat a meal/snack and using a
range pump/meter bolus calculator, the dose of
insulin will be automatically calculated
7.0-8.9 BG level above Give additional By using a pump/meter bolus calculator,
target if done correction insulin if the dose of insulin will be automatically
before a meal about to eat a meal increased to match both the carbohydrate
or snack eaten and bring BG level back down to
target range.
9.0-13.9 BG level too high Give additional By using a pump/meter bolus calculator,
(hyperglycaemia) correction dose of the dose of insulin will be automatically
insulin calculated to bring BG back to target
range.

Check BG 1 hour later if on pump

Check BG 2 hours later if on injections

Change insulin cannula (if using an insulin

pump) if BG does not come down after
initial correction
Above 14 BG level too high Check for ketones If ketones below 0.6, follow advice above
(hyperglycaemia) Give additional (9.0-13.9 mmols/L)
& risk of DKA correction dose of
insulin If ketones above 0.6, insulin dose
calculated by pump/meter bolus calculator
See ‘sick day rules’ needs to be overridden and increased
(pump or injections) (see sick day rules leaflet).
leaflet All correction insulin needs to be given by
injection
Change insulin cannula if using an insulin
pump
Check BG and ketones in 1 hour

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How do I work out how much correction insulin to give?
If you use an insulin pump or a bolus advisor meter, these will work out how much
insulin you need to give. The calculation will be based upon the settings that have
been entered into the device, including what targets are set within the pump or meter;
your insulin sensitivity factor (ISF) and the active insulin.
You can give a correction dose of insulin either by itself in-between meals, or at the
same time as food related insulin, before a meal.
After giving a correction dose of insulin, it is important that you then recheck the
blood glucose level. This should be:
 One hour later if you are using an insulin pump
 Two hours later if you are on multiple daily injections
The second blood glucose level will tell you how effective the correction dose of
insulin has been at lowering the blood glucose level.

The lowering effect of insulin will depend on how sensitive you are to the insulin.
Different things will affect how sensitive you are to insulin. These include:
 Whether you are ill
 The amount of exercise you have done
 How high your blood glucose level is
 How stressed you are feeling
 Whether or not you have ketones

How do you calculate an insulin sensitivity factor (ISF)?

Each child and young person has a sensitivity to insulin (that is how insulin affects
your blood glucose level) based on age, weight, total daily insulin needs and how
long you have had diabetes.
It is expressed as 1unit (rapid acting) insulin = ……..mmols/l drop in blood glucose
level.
The diabetes team can calculate your insulin sensitivity factor for you.

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What is active insulin?
This is a term that refers to how much insulin is still working from previous insulin
injections or boluses. You may also hear it referred to as ‘insulin on board’ or ‘unused
bolus’. It is used as a safety feature to stop over correction of high blood glucose
levels.
Having high blood glucose levels immediately after meals doesn’t necessarily mean
you need more insulin, as the insulin given may still be working to bring the blood
glucose level down. If the bolus calculator in your insulin pump/ bolus advisor meter
recommends that you give a reduced amount of correction insulin or no correction
insulin, it’s because you have insulin active in your system from a previous bolus.
Having this active insulin setting prevents insulin stacking which can lead to
hypoglycaemia.
If you use an insulin pump or a bolus advisor meter, these will take active insulin into
consideration each time a correction dose of insulin is calculated.

If you do not use a bolus advisor meter or an insulin pump, you should not give a
correction dose less than 2 hours after a previous injection of quick acting insulin.

What if I notice a pattern of always having high blood glucose levels

at a certain time?
If you notice a pattern of always having high blood glucose levels / correcting at a
particular time of day, the usual dose of insulin affecting that time may need
adjustment. Please do upload your pump/ bolus advisor meter and contact your team
for advice.

Contact Details:
Office Hours (Mon-Fri 9am to 12pm): 020 3447 9364 (Children’s Diabetes Nurses)
Emergency mobile (Mon-Fri 8am – 6pm): 07940476811
Out of Hours: 020 3456 7890 and page Paediatric On-call Registrar
Email: uclh.cdlime@nhs.net or uclh.cdorange@nhs.net

Further information and fact sheets can be found on our Children and Young
People’s Diabetes web page at www.uclh.nhs.uk/T1

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If you need a large print, audio, braille, easy read, age-friendly or translated
copy of this document, please contact us on 020 3447 9364.
We will try our best to meet your needs.

First published: 19/7/2013

Date last reviewed: 10/08/2018
Date next review due: 10/08/2020
Leaflet code: UCLH/SH/PAED/CYPDS/CORRECTING/2
© University College London Hospitals NHS Foundation Trust

If you need a large print, audio or translated copy of this document, please