My Insulin Pump Broke. Now What?

Would you know what to do if your insulin pump suddenly stopped working?

Or are you considering buying an insulin pump and want to know all the pros and cons?

Research tells us that modern insulin pumps do more for our health than we might think. Yes, they mean an end to regular, daily injections. And yes, a reliable insulin pump paired with a continuous glucose monitoring system (CGM) means you don’t have to do so many calculations. But long-term studies on insulin pump use give a long list of other health benefits for adults and children with type one or insulin-dependent type two diabetes:

• Fewer hypos
• Better HbA1c results
• Lower total daily insulin dose
• Straighter daily glucose curve
• Better sleep quality
• Lower incidence of diabetic neuropathy, retinopathy and diabetic kidney disease
• Decreased systolic blood pressure
• Increased healthy HDL cholesterol
• Overall lower risk of cardiovascular disease and stroke

So what happens when your helpful health-improving insulin pump breaks?!

Here’s the no-stress guide to what to do when your insulin pump stops working.

Broken Insulin Pump? Keep Calm, Keep Safe, Keep Stable

You’ll know if your insulin pump isn’t working properly when it sets off an alarm or your CGM sensor or finger-stick tests give unusual results. The cause of insulin pump failure is often just a kinked or disconnected catheter that stops insulin from entering the body. By replacing or repositioning the catheter, the insulin pump works.

But when it comes to internal (hardware) faults, there’s little we can do. The panic starts to rise.

Keep Calm

There’s no need for panic. You’ve lived without an insulin pump before. Take a few deep breaths and think the next steps through. Staying calm means no stress-related blood sugar peaks.

When you rely on a practically hands-free device, you might get a little rusty with the task that the device replaces, but you still know how to do it.

It’s important to know that all the positive effects listed earlier on are long-term effects. If your insulin pump breaks, those effects don’t suddenly stop.

Keep Safe

In most countries, you can’t just buy an insulin pump and use it without medical approval; your medical specialist will probably already have told you what insulin doses to take if your insulin pump breaks. If not, a quick phone call while your pump is still working faithfully is the right solution. Pin your non-insulin pump dosage schedule on the fridge or on your smartphone homescreen – that way, you’re always prepared.

Has your insulin pump broken but you don’t have a dosage schedule to hand? Contact your health provider or diabetes specialist asap. Middle of the night? It’s absolutely OK to contact the on-call doctor. He or she might not be a diabetes specialist, but will know how to safely bridge the insulin pump gap before you can contact your trusted diabetes care provider.

Help an unfamiliar doctor calculate the right insulin dosage by always noting down your most recent insulin pump basal and bolus data. This information should be easily accessible (on a smartphone document that can be accessed offline, for example). How about installing the Diabetes:M app? With its bolus advisor and insulin pump compatibility features, you can store and access the following information at any time:

• Basal: rate, times and total daily basal insulin
• Bolus: carbohydrate ratios/times, sensitivity (correction) factor/times and target blood glucose/times

When your insulin pump stopped working, your body stopped getting regular, tiny doses of fast-acting insulin. It’s therefore essential to have back-up equipment close to hand. Injectables, a finger stick blood glucose testing device (in case your CGM stops working), and urine testing strips for diabetic ketoacidosis should always be within reach.

Don’t try to fix a broken insulin pump. The only part of an insulin pump that can be removed and replaced are the catheter (if it’s a tubed insulin pump), insulin vial, and battery. Most insulin pumps have specific alarms for each of these. Replace or charge the faulty part and see if your insulin pump works again. If it is, there’s no need to inject additional insulin.

Keep Stable

Your insulin pump isn’t working, your glucose levels are rising, and there’s nothing wrong with the battery, catheter or insulin cartridge. But you’re calm. You have all the necessary back-up equipment close at hand, and you know how much exactly insulin to inject. Follow these simple recommendations:

• Remember, the minute you begin to administer insulin manually, you’re taking over the role of the insulin pump. So turn off your insulin pump if it hasn’t already turned itself off. You don’t want to double the dose if the fault is temporary.
• Check your CGM results or carry out finger prick tests at regular intervals. If you wake up to a broken insulin pump and don’t know how long you’ve been without insulin, or if your glucose readings are over 260 mg/dl, check for ketones.
• Avoid carb-dense meals to keep your glucose curve as even as possible.
• Don’t administer corrective doses for high blood glucose in the first two hours unless advised by a doctor. The best insulin pumps have an active insulin feature that calculates how much of this hormone is available to the body at any one time. When this data isn’t available, manually-administered corrective doses might bring blood glucose levels too low.
• Contact your doctor or a doctor on call if you need clarification on any readings, symptoms, or dosages.
• And contact your diabetes care team during opening hours to inform them about your broken insulin pump. They will arrange any additional prescriptions, like long-acting insulin.

Contact Your Insulin Pump Manufacturer

Once you are calm, safe and stable, it’s time to deal with the administration side of things. This means contacting both your diabetes care team and the customer support services of your insulin pump brand. The majority of medical customer care departments are available 24/7.

A replacement insulin pump could arrive in as little as 24 hours; however, be prepared for a longer wait. It’s very likely that your diabetes specialist will prescribe long-acting insulin during this waiting period.

As long-acting insulin remains in the body for much longer than the rapid-acting insulin used in every insulin pump, you can’t start with the replacement insulin pump straight away. Either connect the new pump and set a temporary basal dose of zero for the first 24 hours (the top insulin pump brands have temporary basal dose options). Alternatively, don’t reconnect the new pump until 24 hours after your last long-acting insulin injection.

Program your new device with the same settings as the broken insulin pump unless otherwise advised by your diabetes care team or specialist. If the replacement device is a newer insulin pump model, the manufacturer’s customer support will help you set it up over the phone. If they don’t automatically offer this service, just ask.

Temporary Solutions

When an insulin pump manufacturer can’t deliver a new insulin pump within a matter of days, don’t worry. Many larger diabetes clinics have replacement pumps (loaners) available for exactly these circumstances. In some circumstances, it’s even possible to request a loaner from the manufacturer or a handful of medical support organisations. Of course, loaner insulin pump availability is very dependent on your country’s health insurance options. Here’s a shortlist of examples:

• United States: Edwards Health Care Service offers insulin pump loaners for eligible members;
• Global: Medtronic offer a low-cost insulin pump rental but only for travel purposes. This offers additional peace of mind if your Medtronic insulin pump breaks while abroad;
• UK: insulin pumps for T1D are covered by the National Health Service (NHS) and a replacement insulin pump should be made available via your diabetes care team;
• Europe: contact your state or private health insurer for more information on insulin pump rental, as requirements may vary from country to country.

Your diabetes care team or regional diabetes association forum can provide plenty of information.

Insulin Pump Insurance?

Expensive insulin pumps can only be used by people with type one diabetes or insulin-dependent monogenic, gestational, or type two diabetes. This means all insulin pump users are in regular contact with medical specialists and, in the majority of cases, (a percentage of) costs are covered.

If your insulin pump is faulty within the warranty period and you have used the pump and accessories according to the manufacturer’s guidelines, the manufacturer is obliged to provide a replacement.

But please keep in mind that if you drop or knock your pump and it stops working, or if you don’t use approved accessories, the manufacturer has the right to refuse one.

Different parts of the world offer widely varying medical insurance coverage. Some pay a small percentage of insulin pump costs, while others are much more generous. It’s worth speaking with your diabetes care team to find out your most cost-effective options.

As the average insulin pump cost is around US$5,000, it’s worth looking for private insurance plans that cover the term of the warranty period, especially when your medical insurance expects you to pay a percentage. Read the fine print and ask plenty of questions when you contact local or global insurance companies. Ask about their policies regarding repairs and replacements for dropped devices, for example.

Can I Afford A New Insulin Pump?

Financial constraints may prevent you from buying an insulin pump replacement outright. In this case, it’s vital that you speak with your diabetes care team.

It’s perfectly possible to keep daily curves stable using manual injection techniques, especially in combination with a CGM. However, there are many insulin pump benefits. Your diabetes care team might be aware of an organisation that covers the costs of expensive diabetes equipment for those who can’t afford it.

Joining an online diabetes community and speaking to people in the same part of the country might bring other options to light. Someone might have been assisted by a local organisation you never knew about. Or you might be encouraged by others’ tips and advice to continue with manual injections. After all, with diabetes, there’s no ‘one size fits all’.

Just type ‘diabetes forum’ into the search bar along with your region or country. Opt for national associations where possible, like The American Diabetes Association forum, the Diabetes UK Diabetes Support Forum, or the Diabetes Australia online member community. The Diabestes:M app also has a helpful community forum with members who are more than willing to share their experiences and ideas.

Prevention is Better Than Cure

There are ways to prevent an insulin pump fault or at least minimise the risk of breakage. Regular maintenance and servicing within the warranty period usually involve some costs but are strongly advised. In fact, you may be required to send your pump in for annual servicing by your insurer or the manufacturer.

Upon receiving a new insulin pump, take time to read through the manual from cover to cover. Familiarise yourself with the different alarms and troubleshooting information. Make sure any accessories you use are approved by the manufacturer. Even the type of cleaning product you use on your insulin pump may have an effect on the warranty. Check water resistance and storage temperatures; you often must protect an insulin pump against high humidity or temperature extremes.

To avoid breakage by drops and knocks, use approved pockets and belts.

My Insulin Pump Broke, And I Know What To Do!

It’s annoying. Your expensive piece of medical equipment has suddenly stopped working and will probably need to be replaced.

But you know exactly what to do about it.

1. You have alternative insulin administering options close at hand, along with the right dosage information.
2. You’ve notified your diabetes care team and the manufacturer about what happened.
3. You know how to bridge the insulin pump gap with long-acting and short-acting insulin until your new pump or loaner arrives.
4. You know what insurance cover you have and how to make a claim, or know of an organisation that can help with the cost of a replacement insulin pump.
5. Or you’ve decided to continue with daily injections for a time after learning from others’ experiences.

Yes, a broken insulin pump is annoying. In fact, it can be dangerous. But only if you don’t know what to do.

And now, you do.