Imagine a scenario where your pump breaks or malfunctions. The pump company will be sending a replacement within the next 24hrs, but what do you do in the meantime? Do you have a backup plan? And equally as important…do you know how to use your backup plan? Below are general backup plan guidelines. Please discuss with your clinician before implementation.
First, you will need to take long acting insulin (Tresiba, Toujeo, Lantus, Levemir, Basaglar). Generally, the amount of long acting insulin required will be similar to your insulin pump’s 24 hr total basal. This can be found in your pump’s personal profiles of insulin settings. Inject the 24hr total basal dose as long acting insulin. For example, if your basal rate from 12am-12am is 0.85 u/hr, you will need to inject ~20 units (0.85 x 24 = 20.4u) of long acting insulin daily. It is always a good idea to keep your setting written down just in case you are unable to access them when/if your pump malfunctions. Remember, this amount will not be perfect, but it is a good starting point. Monitor your blood glucose closely. Keep in mind Toujeo and Tresiba take 4 or 5 days to equilibrate (reach a steady state) and you will have to give more correction boluses for the first few days. Lantus may be a better option if you are going off the pump temporarily.
Alternatively, if you do not have long acting insulin available, you can correct every 4 hours using rapid acting insulin. Yes, this means waking up every 4 hours overnight as well. Afrezza (inhaled insulin) can also be used to correct even when the fast acting insulin is given every four hours and you are still high. You are much better off having long acting insulin on hand.
When deciding how much to bolus, you will need to know your pump’s programmed carb and correction factors, also found in the insulin settings. See the equations below for help with calculations…
Total Carbs/Carb Factor = X units
(Blood glucose – target glucose)/Correction Factor = Y units
X + Y = total units
Remember, do not correct if it has been less than 3 to 4 hrs since your previous dose. This will help prevent hypoglycemia caused by insulin stacking.
When restarting your pump, make sure it has been at least 24hrs since you last injected your long acting insulin. Alternatively, set a 0% temp basal rate for the remaining hours in the 24 hour period.
For example; if your last injection of Lantus was at 8am and you are starting your new pump at 5pm, set a temp basal of 0% for ~15 hours.
Remember, it’s not enough to just have a backup…know how to use it!