Technology: can’t live with it, can’t live without it. It’s great when it works like it's supposed to, but when it doesn't, it can be a huge source of frustration! Dangerous fluctuations in blood glucose (BG) and potentially serious changes to our health can occur when technology fails. So the more we can be prepared to take quick and effective action, the better off we are.
Despite the best efforts of insulin pump manufacturers to produce high-quality, reliable products, occasional problems can still occur. But as pump users, there is a lot we can do to minimize pump-related problems.
- Change your pump/infusion set at least every 72 hours.
- Evaluate unexplained high BGs in a timely fashion:
- Check your infusion site at least once a day for redness, inflammation, warmth, and loose adhesive. Change immediately if any problems are detected.
- Promptly purge any bubbles in the tubing if necessary. Use room temperature insulin to keep air bubbles to a minimum.
- With unexplained high readings, take corrective doses via injection rather than with the pump. If the injection doesn’t bring your BG down, switch to a new insulin vial.
- Do not suspend insulin delivery or disconnect pump for more than 90 minutes without replacing missed basal insulin on an hourly basis.
- Change or charge your battery upon first alert.
- Change or fill your insulin reservoir at the first alert.
Be vigilant and check for problems on an ongoing basis so they can be detected at the earliest possible time. Pumpers are more vulnerable to ketones and Diabetic Ketoacidosis (DKA) due to the absence of a long-acting insulin.
If you are switching over to a new pump, be certain that all of your settings are transferred over correctly. Evaluate your records on an ongoing basis to be sure your settings work effectively for you, and get help if they don't.
Mechanical pump failure
There's nothing more frustrating than getting an alarm telling you that there is a serious problem with your pump; it’s analogous to the “blue screen of death” on a computer. When this happens, call the pump manufacturer right away to troubleshoot, and start the process of getting a replacement pump if necessary.
Remember that your pump is a sensitive piece of equipment. Know what the manufacturer's recommendations are for keeping the pump clean. Most pumps can be wiped with a damp, lint-free cloth. Do not expose it to cleaning products or harsh solvents. Also, check whether your pump can withstand exposure to things like x-rays, airport security equipment, MRIs, and sudden drops (such as on an amusement park ride).
Keep your pump away from moisture if it's not waterproof. The Pods in the Omnipod System are waterproof*, but the PDM is not. Other pumps on the market have varying degrees of resistance to moisture. If you wear a tubed pump next to your skin, be sure the buttons face away from your body. Moisture from perspiration can lead to pump failure, particularly if there is a break in the pump's casing.
Consider keeping your pump in a case that will protect it if it's inadvertently dropped. If it is dropped, do a careful inspection, noting any scratches, cracks, or other damage. If you find anything wrong, contact the pump manufacturer immediately. Most will send you a new pump overnight, provided your pump is under warranty.
Plan for a pump failure
- Keep a vial or pen of long-acting (basal) insulin in your refrigerator as an insurance policy.
- Talk to your healthcare providers in advance so you know how much basal insulin to take via injection, and have a plan for temporarily switching over to Multiple Daily Injections (MDI) if you have to take a break from using your pump.
- Ensure you have necessary syringes or pen needles available.
- Have ratios written down to calculate how much insulin to take for a correction, food and how much insulin you have on-board following a bolus injection.
- Keep phone numbers for your providers someplace where they are easy to find, and share this information with your loved ones in case they need to help you.
Maintain a printed list of your current pump settings someplace where you can quickly put your hands on it. You will need this list of pump settings to program the new pump when it arrives. This includes basal settings, Insulin to Carbohydrate Ratio (I:C), sensitivity/correction factor, active insulin time, target BG, maximum bolus, maximum basal rate, etc. If you download your pump regularly, you can also check your download for the last settings that were active.
As the saying goes, an ounce of prevention is worth a pound of cure. If you have a solid plan in place, it's a lot easier to stay out of trouble and get back on track.
*The Pod has a waterproof IPX8 rating for up to 25 feet for 60 minutes. The PDM is not waterproof.
-Gary Scheiner, MS, CDE