When your insulin pump stops working!

The checklist below can help get you started:

• What does the pump screen say?
  - If the pump has malfunctioned there will usually be a code on the screen.
  - The screen may provide some steps you can take to help resolve the issue.
  - You can also check the product manual for help.
• Has insulin delivery been suspended or stopped?
  - Check the cannula insertion site – could the cannula be kinked? Is the skin around the site red, sore or swollen? Is there moisture or can you smell insulin? This is a sign there’s a leak
  - Check the tubing for air bubbles and that all connections are correctly in place.
• Check your glucose level.
  - Use your CGM on another device or do a finger prick.
  - If your glucose level is above target, insulin may not have been delivered.
  - Check blood ketones.
  - You may need to follow your sick-day plan.
• You may be able to resolve the issue yourself by:
  - Doing a full cartridge and line change
  - Checking your insulin is in date and has been correctly stored
  - Making sure your pump settings are correct – date, time, basal program, carb ratios and corrections.

If your pump has malfunctioned and cannot be fixed, then you need to report this to the pump company ASAP. Each company has a 24-hour phone support service, and they generally arrange a replacement pump for you within 24-48 hours if you are eligible.

If your pump is more than 4 years old and out of warranty, speak to your diabetes educator or treating team about what to do next.

While you wait for a replacement pump to arrive, you will need to take your insulin by pen injections.
This means both long-acting and quick-acting insulin for a few days.

It may be challenging to go back to insulin pens for a while, but here’s where to start:

• Always have a current prescription and in-date supply of long-acting insulin on hand (in your fridge) in case you need it.
  This could be in cartridges or disposable pens.
• If you fill your pump cartridge from a 10ml insulin vial, you will need a prescription for 3ml cartridge insulin to use in a pen
• Make sure you have insulin pens available to use for both types of insulin.
• Make sure you have some pen needles to put on the insulin pens.
• If you can, find your ‘Total Daily Dose’ (TDD) in the pump history or refer to a previous pump download to find this information.
  - This will help you and your diabetes health professional to work out the insulin doses you need while on injections.
  - Generally, half your TDD will be given as long-acting insulin once or twice a day; the rest will be given as quick-acting insulin for meals and corrections.
  - Continue to count carbohydrates as normal and use your ICR (insulin to carbohydrate ratio) to work out how much quick-acting insulin to have with your meals.
  - You may also need to have some extra quick-acting insulin as a correction if your glucose levels are above target.
  
  

If you are unsure about using pens and insulin doses you can get advice from your usual diabetes educator or treating team or contact the Victorian Virtual Emergency Department for assistance: https://www.vved.org.au/

When your replacement pump arrives, you can breathe a sigh of relief and get started with setting it up and reconnecting.

Here are some things to keep in mind:

• Use your old pump’s settings to guide the set up; you might remember these or have them in a previous download.
• Your diabetes team will be able to help you or ask the pump company for assistance.
• If you have been using pen insulin for a few days, you’ll need to allow for long-acting insulin still being in your system when you reconnect the pump.
• Keep an eye on your glucose levels closely and speak to your diabetes educator for advice about your situation.

Remember, it may take a few days for things to get back to ‘normal’.

The pump company will usually ask for you to send the old pump back to them to be checked and will help you to do this at no cost. While they will investigate the reason for a product malfunction, you are unlikely to find out exactly what happened.

Insulin pump malfunctions can happen when you least expect it. It’s worth making sure you are prepared for the unexpected and have the tools you need on hand ready to manage safely if and when this happens to you.