Rates of insulin pump use in people living with type 1 diabetes (T1D) have been increasing worldwide. There are times, however, when insulin pumps malfunction or fail, just like any other technology. 

When this happens, a backup plan will come in handy — especially when it’s the middle of the night or you’re away from home. While calling the insulin pump company may provide an easy fix, you could also need a replacement pump, which means some waiting time.  

In other words, you’ll need a “plan B” for managing T1D while you’re waiting.  

 

What’s a backup plan? 

A backup plan is a set of “what to do” instructions when a diabetes management tool has failed. In this case, it’s an automated insulin delivery (AID) system or sensor-augmented pump. 

Without the pump on, your glucose levels will inevitably rise. That’s because the fast-acting insulin in a pump also acts as your basal or constant stream of insulin.  

If you only disconnect for a few hours, you may only need a fast-acting insulin. This is the same type of insulin that goes into your pump. If it’s longer than that, you’ll want to add in long-acting insulin. Here’s why. 

A pump malfunction can cause diabetes ketoacidosis (DKA). This is when you don’t have enough insulin in your body, and it breaks down fat for energy. Ketones can make you very sick. Even being disconnected from a pump for a few hours can cause your glucose to rise quickly.  

If you don’t have a backup plan, it’s a good time to make one. Reach out to your diabetes care team or have it on your to-do list for your upcoming appointment. There are more than a few things to think through. 

 

Let’s start with supplies. Do you have the following on hand?  

  • Insulin syringes or pen needles 
  • Long-acting insulin (vial or pen) that’s not expired 
  • Ketone test strips (you can purchase these over the counter) 

 

Part of your backup plan will be knowing what to do in case you have ketones in your urine. Your healthcare team will inform you about next steps, but if you’re ever in doubt, call them or seek emergency care. DKA can be a life-threatening condition.   

 

Taking a longer “forced” pump break 

Out of the gates, there are two people you’ll need to call for extra support: your insulin pump company and your healthcare team.  

The pump company can walk you through troubleshooting your pump issue. Your healthcare team can provide any necessary support. This may include help with a long-acting insulin prescription, how many units to take, and guidance on other ratios that may have been happening automatically with your smart pump.  

You’ll need to add long-acting insulin because, again, you won’t have a steady rate of fast-acting insulin in the background. So, if it’s going to take time to restart your pump, long-acting insulin is necessary. Otherwise, glucose levels will rise even if you’re taking mealtime insulin. 

 

What are today’s options for long-acting insulin? 

Let’s take a closer look at the different types of long-acting insulin.  

Insulin glargine (Rezvoglar, Basaglar, Lantus, Semglee) is taken once daily and lasts about 24 hours in the body. For some people, it’s necessary to take it twice a day. After opening, it’s good at room temperature for 28 days.  

Insulin degludec (Tresiba) is taken once daily and lasts about 42 hours in the body.  After opening, it’s good at room temperature for 56 days. 

Insulin glargine U-300 (Toujeo) is a more concentrated form of insulin glargine taken once daily and lasts about 36 hours. After opening, it’s good at room temperature for 56 days. 

Insulin NPH (Novolin N and Humulin N) is an intermediate-acting insulin taken twice daily and lasts about 14 hours. This insulin is more affordable, but it’s older and comes with a higher risk of hypoglycemia (low glucose). 

 

How do I know how much insulin to take? 

Talk to your healthcare team about your individual needs. Insulin needs vary from person to person. If you’re comfortable doing so, you can calculate a long-acting dose by looking at your pump’s average basal insulin dose.   

You can find this in the pump history menu or on a pump report.  At each visit, you can ask your healthcare provider if the insulin amounts in your backup plan need updating and if you have an active prescription. 

AID systems constantly adjust the amount of basal insulin to keep your glucose in target range. It’s normal to have varying amounts of insulin delivered by the pump day to day. That’s why it’s best to look at the average units delivered and not just programmed basal rate settings.   

 

When should I take long-acting insulin? 

Long-acting insulin takes time to work. Usually, when taking a planned “pump break,” someone will take long-acting insulin two hours before disconnecting.  

On the other hand, having a pump failure is always a sudden and unexpected event. Once the outcome is clear, you’ll want to take long-acting insulin as soon as possible.  

If your blood sugar is high, you’ll want to take rapid-acting insulin (as prescribed) to bring your glucose into the target range. You’ll also want to check for ketones.   

 

When traveling, keep the following in mind:  

Pack extra pump and CGM supplies. Double the number of sensors, infusion sets, and reservoirs you will need. It’s better to have too much than too little.  

Carry backup insulin. Pack rapid-acting and long-acting insulin. If using vials, make sure you have syringes. If using pens, make sure you have pen needles.

Keep unused insulin cold. Store unused insulin in a refrigerator or use a portable cooling option.  

Record your backup plan and pump settings. If your pump breaks down, you may not be able to see your settings. However, you can generally access them on the manufacturer’s app. You can also save a picture on your phone, store it in your phone’s notes, on a paper note, or elsewhere on an accessible digital device. 

Know how to contact your healthcare team. Your pump may malfunction in the middle of the night or when you’re traveling in a different time zone, for example. Your healthcare team should always have someone “on call.” You can reach out with questions.  

Try to stay calm and level-headed. It can be scary or frustrating when things go wrong, but it helps to stay calm so you can tackle the problem at hand. You will not want to go long without taking insulin, so prioritize this. 

 

Wherever you are, having a pump failure can be an inconvenient and frustrating experience. When you’re not at home, you may have limited access to supplies and need to find a local pharmacy. Either way, having a backup plan and knowing what to do can make everything much easier. 

 

 What If I don’t have long-acting insulin? 

Some insulins are available without a prescription at a local pharmacy, and there are several resources to access lower-cost insulin. Your diabetes team will provide guidance as well as insulin-dosing instructions to get you through this inconvenient and stressful time. 

 

When can I get back to pumping? 

If your pump is replaced or you have a temporary loaner, you must program it with your previous settings. You can usually log into a pump portal to view them. If you’re unsure where to find them or want to double-check if they’re right, reach out to your care team. 

Keep in mind that long-acting insulin stays in your system for at least 24 hours. One option for restarting on your pump is to wait 24 hours after the last long-acting dose. If you’re in doubt about how or when to start pumping again, your care team will provide instructions. 

Nothing about diabetes is perfect — and technology has its fair share of hiccups. But with some preparation and a solid backup plan, you’ll be ready to tackle an insulin pump failure from anywhere!