Do you know what to do if your insulin pump malfunctions or fails? 

I can attest it’s a sobering moment that unleashes a flurry of questions: What time is it? Is my provider’s office open? Should I call the insulin pump company? Do I have unexpired, long-acting insulin in the refrigerator? Do I even know how much to take?  

If you live with type 1 diabetes (T1D), you’re likely familiar with this scenario. Although pump malfunctions are thankfully a relatively rare occurrence, they can happen at any given moment — and many people living with T1D are unprepared for it.  

It’s true that taking a spur-of-the-moment, forced “insulin pump break” can be stressful. One thing is for sure: We can’t predict the future, and I don’t know about you, but these things tend to happen at inconvenient times for me (yes, I’m talking while on vacation and in the middle of the night). 

That’s why it’s important to have a plan in place.  

By not only expecting but being prepared for the challenges that may erupt, you can pivot and not have them be such a big deal. This way, you can have peace of mind, even if the dreaded “black screen of death” appears or the ear-piercing squeal of a malfunction resounds. Let’s break it down.  

 

How many people on insulin pumps have “just in case” long-acting insulin prescriptions? 

Researchers set out to learn. After identifying that 54% percent of patients seen between February and August 2021 at the Barbara Davis Center had an active, long-acting insulin prescription, they designed a quality improvement initiative to improve backup planning for insulin pump failure. Their initial focus was on improving these prescription rates. 

With a series of implemented process changes and interventions — including a prompt for the diabetes care team to provide written long-acting insulin dose instructions — prescription rates increased to 70% by May 2022.  

  

Why do you need long-acting insulin if your pump malfunctions? 

Taking steps to address a failed insulin pump or automated insulin delivery (AID) system is high priority. That’s because you’ll need both short- and long-acting insulin to replace your pump’s bolus and basal capabilities. 

Without injected insulin, you are at risk of quickly developing diabetic ketoacidosis (DKA), a potentially life-threatening condition.   

At first, you may notice familiar symptoms of high blood glucose, such as increased thirst and urination.  

Over time, ketones will develop in your urine, along with other hallmark signs of DKA, and need prompt treatment. That’s why it’s important to have a backup plan in place. 

Symptoms of DKA include: 

  • Muscle aches 
  • Nausea/ vomiting/ abdominal pain 
  • Extreme tiredness 
  • Fruity breath 
  • Difficulty breathing 
  • Confusion and even unconsciousness 

 

What do people living with T1D have to say? 

Regardless of the brand or model, insulin pump malfunctions and failures can happen. While defects, software issues, and failures can occur — kinks, occlusions, and disconnections are possibilities, too. You’ve likely experienced one of these as an insulin pump wearer. 

“I once had an insulin pump failure while traveling out of the country,” said Veronica Bridgeforth, who has lived with T1D for 27 years. “The device malfunctioned, and my glucose became very unstable. My experience taught me the importance of having a backup plan — and staying calm under pressure.”  

Veronica isn’t alone.  

Chantal Murray, who has lived with T1D for 23 years and has used an insulin pump for 17 years, explained, “Having a long-acting insulin prescription as a backup is needed. It provides a safety net and reduces anxiety about pump failures. Being without a pump is torture. It changes habits and adds more ‘thinking’ to diabetes management. When used to pump management, unexpectedly switching to multiple daily injections (MDI) is lifesaving, but it can be very inconvenient.” 

“I honestly would be more afraid to use long-acting insulin if my pump failed because I haven’t had to use it in over ten years,” said Portia Benbow, Founder of DiaBeating the Odds, highlighting the challenges of transitioning back to injections. 

 This initiative hits close to home, as I’ve lived with T1D myself for over 40 years — using an insulin pump for the past 17. A few months ago, my insulin pump failed, and I didn’t have long-acting insulin on hand. My doctor’s office was closed, and only a few pharmacies were open.  

I was filled with anxiety because I didn’t have a backup plan, and I didn’t know how much insulin to take. Knowing providers are actively taking steps to ensure better backup plans for pump users is incredibly comforting. 

 

How can you plan for an insulin pump malfunction?  

Be proactive. If your diabetes care team hasn’t provided instructions to follow in case of an insulin pump malfunction, request them. 

You can start the conversation with your diabetes care team at your next appointment — before you have an issue with your pump. Then, you’ll be sure to have everything in place if it occurs. 

Consider asking the following questions: 

  • What are the steps for troubleshooting a malfunctioning pump?  
  • Who do I call first? (insulin pump company, diabetes provider’s office) 
  • Can I have a prescription for long-acting insulin, syringes, and/or PEN needles? 
  • Where in the process do I transition to long-acting insulin? 
  • How do I safely deliver insulin manually? (with a syringe or PEN) 
  • Can you provide dosing instructions for long-acting and short-acting insulin? (store in your phone notes so it’s always with you) 
  • When can I safely resume using my pump after taking long-acting insulin? (having access to your insulin pump settings in an app can come in handy) 

 By working closely with your diabetes care team, you can create a safe and effective plan for handling any diabetes technology issues that come your way.  

It’s normal and expected to need support with an insulin pump malfunction. So, don’t hesitate to ask for help — no matter the time of day or night.