About a month ago I put out a Sick Day Plan Template. In this blog I have put together a broken pump plan template. This is a plan to follow if you use an insulin pump and it has a systematic failure.
Unlike the Sick Day Plan, there are Broken Pump Plans out there so I have merged a few of them to create what I believe to be a practical approach to a disastrous event. The main sources for this template are:
- https://www.uhn.ca/PatientsFamilies/Health_Information/Health_Topics/Documents/My_Insulin_Pump_Backup_Plan.pdf
- https://www.adces.org/danatech/insulin-pumps/troubleshooting-pumps/pump-back-up-plans
- https://diabetes.telethonkids.org.au/siteassets/blocks—childrens-diabetes-centre/cdc—pump-failure-guidelines.pdf
- https://www.uhd.nhs.uk/uploads/services/docs/diabetes/Managing-illness-on-an-insulin-pump-back-up-leaflet-COVID-19.pdf
- https://pedsendo.org/patient-resource/insulin-pump-failure-a-guide-for-families/
- https://www.hamiltonhealthsciences.ca/wp-content/uploads/2019/08/DiabetesPumpStopWorking-lw.pdf
- https://www.cdc.gov/diabetes/basics/diabetic-ketoacidosis.html
As with the Sick Day Plan, I am not a medical professional so I strongly recommend running your version of this plan past your health care team before using it.
The Template
Contacts
| Relationship | Name | Contact Number |
| Diabetes Educator | <DE Name> | <DE Phone Number> |
| Insulin Pump Supplier | <Pump Support Name> | <Pump Support Number> |
Things to Carry
- Short-acting insulin
- Long-acting insulin
- Needles for injection
- Glucometer and strips
- Lancet/Genteel
- Ketone strips
- Hypo snacks
Pump Settings
| Target | <Target blood glucose level> | |
| IC ratio | <IC ratio number> | Grams of carb 1 unit of insulin covers |
| ISF | <ISF number> | The amount blood glucose levels drop with a unit of insulin |
| Basal | <Basal number> | How many units per hour needed for basal insulin |
| TDD | <TDD number> | Total daily insulin usually used (bolus + basal) |
NB: This is quite a simplistic profile as it assumes no variation over the day. Also, if looping, numbers may not be accurate as the loop may have adjusted the profile within its algorithm so monitoring is essential.
DKA Symptoms to Watch For
DKA usually develops slowly. Early symptoms include:
- Being very thirsty.
- Urinating a lot more than usual.
If untreated, more severe symptoms can appear quickly, such as:
| Fast, deep breathing | Muscle stiffness or aches |
| Dry skin and mouth | Being very tired |
| Flushed face | Nausea and vomiting |
| Fruity-smelling breath | Stomach pain |
| Headache |
Steps to Follow
NB: Assumes a mechanical/electrical pump failure, not a cannula issue
- Call the pump manufacturer to report the fault and find out when a new one can be delivered
- If tech support can’t fix it, stop the pump and disconnect it
- If you have one, activate your spare pump
If off the pump for less than 3 hours:
- Check blood sugar
- If above target inject rapid insulin to bring it down, if very high (>14 mmol/L, >250mg/dL) check for ketones
- If showing signs of DKA (thirsty, excessive urination, vomiting, headache, exhaustion), check for ketones, regardless of BGLs
- If ketones above 1.5mmol/L, double the correction dose (or add 10-20% of your TDD), drink a glass of water every 15 minutes. If BGLs are not high, also eat a hypo snack to counter the extra insulin
- If you eat, inject rapid insulin to match the carbs
If off the pump for more than 3 hours:
- Check blood sugar every 4 hours
- Calculate the basal insulin needed for 4 hours
- Inject enough rapid insulin to cover it
- If above target inject rapid insulin to bring it down, if very high (>14 mmol/L, >250mg/dL) check for ketones
- If showing signs of DKA (thirsty, excessive urination, vomiting, headache, exhaustion), check for ketones, regardless of BGLs
- If ketones above 1.5mmol/L, double the correction dose (or add 10-20% of your TDD), drink a glass of water every 15 minutes. If BGLs are not high, also eat a hypo snack to counter the extra insulin
- If you eat, inject rapid insulin to match the carbs
- If without a pump overnight and do not have long-acting insulin, continue every 4 hours
If off the pump overnight or more than one day with long-acting insulin:
- Check blood sugar every 4 hours
- Calculate 24 hours total basal (or 2*12, whichever works)
- Inject long-acting insulin to cover it
- If above target inject rapid insulin to bring it down, if very high (>14 mmol/L, >250mg/dL) check for ketones
- If showing signs of DKA (thirsty, excessive urination, vomiting, headache, exhaustion), check for ketones, regardless of BGLs
- If ketones above 1.5mmol/L, double the correction dose (or add 10-20% of your TDD), drink a glass of water every 15 minutes. If BGLs are not high, also eat a hypo snack to counter the extra insulin
- If you eat, inject rapid insulin to match the carbs
Reintroducing a new pump:
If not looping or having basal suspension, consider the insulin on board before activating the basal rate of the pump. For example, reconnect when you would otherwise give yourself a basal shot
The Practical Diabetic 