AID & Insulin Pump Back-Up Plans

In the event of an insulin pump malfunction, it’s good to have a back-up plan. We created these tips to help users be prepared.

Traci Carter MA, RN, CDE; Anna Isfort, MD; Karen Vogt, MD; Jill Emerick, MD, DKA, Quality, and Costs: How a Written Back-Up Plan Saves Money and Lives

PDF Download: Pump Back-up Plan


Addressing Insulin Pump Malfunction

Pump Set Change Precautions

Always be aware of your Blood Glucose (BG) trends. When placing a new cannula, pick a time early in the day so you can monitor your BG. This will reassure you that the tubing and/or the insertion set is not kinked, leaking or blocked. If there was a problem with the flow of insulin, it may take several hours for the pump to alarm or it may not alarm at all. Check your BG at regular intervals in the hours after a change. Do not go to bed right after a set change. Watch your BG and/or CGM device throughout the day to make sure there are no trends caused by lack of insulin.  

What Next? 

If you notice BG readings above 300mg/dL twice in 2 hours after a bolus insulin (correction) and it continues to rise, suspect a pump set failure. Check ketones. 


When Do We Suspect Pump Set or Pump Failure? 

  1. You have symptoms of high BG. Examples: thirsty, frequent urination, tired, fruity breath, stomach aches
  2. If the ketones are positive 
  3. If high BG results continue even after correction 

Act Fast

Stop the pump and give the Novolog correction factor by using your insulin pen or syringe/vial. Change the insulin pump cannula, tubing and resume your basal rate. Continue to check your BG at 30 minutes and then hourly until you are sure the infusion set is working properly and the BG results stay under 300mg/dL. 


Pump Back Up Plan

In case you are not certain the pump or tubing is working correctly, use this plan: 

  • Contact the insulin pump company representative to troubleshoot the problems. (Help numbers are on the back of the pump device.) 
  • Stop the pump and disconnect the tubing and insertion set. 
  • If you will be off the pump for more than 1-2 hours without a basal rate, you must correct with Novolog or switch to a long-acting insulin plan. 
  • Option 1: Correct using Novolog pen or syringe/vial with the insulin sensitivity factor (correction) every 3 hours. Use Novolog injections for your carbohydrate ratio with meals. 
  • Option 2: Use long-acting insulin plan (Lantus) after pump stops. Novolog injections for your correction factor and carb coverage at meals. 
  • When using Lantus, don’t restart your usual pump basal rate on that day. This will cause low BG. Ask us for help transitioning back to the pump when ready. 
  • Be careful about high or low BG results during these changes in insulin therapy. Recheck ketones. Follow the sick day ketone plan and increase drinking of un-sweetened fluids. Carry fast-acting carb choices like glucose tabs. 
  • Contact the Diabetes Educator or the Pediatric Endocrine Doctor On-Call 
  • Ask about updating your insulin back up plan at every routine visit. Check your Lantus expiration dates and keep refills refrigerated. Replace an opened vial/pen every 28 days. 

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