If you use an insulin pump do you have a backup basal insulin in case your pump fails?
I have long acting insulin (ex Lantus, Levemir)
I have extra long acting insulin (ex Tresiba, Toujeo)
I have intermediate acting insulin (NPH)
No
0voters
If you have to use your basal insulin
I know how to calculate a basal insulin dose, no problem
I would need help figuring out a basal insulin dose
I need to talk to my doctor about planning for a pump failure
0voters
A couple of people posted last year about pump failures, not having backup basal insulin and had trouble using it. I figured the start of a new year was a good time to talk backup plans.
I answered your poll even though I am on a pump break at the moment. In 20+ years of pumping I don’t think I ever had a backup insulin. I rarely, if ever, had problems with my pumps (mostly Minimed and then Tandem for the last 6 years). They were workhorses, but not as high tech of course as pumps today.
Thanks for the prompt to actually check my supplies that comprise my back-up insulin plan. I’m currently using the Loop DIY system with the Mini-Med 722 insulin pump paired with the Dexcom G6 CGM. The MM 722 is at least 15 years old and of course carries no warranty. I have an extra MM 722 pump as my first back-up.
I checked my fridge and found several Tresiba pens with an expiration date of January 2023. I assume these pens are still reliable but I will ask my endo at my late January appointment to write a new Rx for Insulin Degludec (my Rx plan’s Tresiba equivalent) to freshen up my stock.
I think pump users should switch to MDI periodically so that they’re comfortable with the routine when circumstances dictate. This is where my plan weakens. The last time I did the MDI switch was 2016.
Examining my daily insulin doses tracked in Apple Health, my daily basal dose varied from 10 to 16 units per day in the last month or about 13 units daily average. My best guess for a starting dose of Degludec would be 12 units. I realize that this insulin takes several days to reach its “steady state” dose. I expect to make some up or down adjustments spaced about three days apart.
Unlike MDI basal rates, Loop adjusts the basal insulin dynamically. This is a bit of a downgrade for me, yet I take comfort in the fact that many MDI users successfully use this method.
In 23 years of pumping, I’ve only been completely off the pump for a couple days maybe three times, due to pump failure. I hate waste, and I don’t have basal insulin waiting for those very rare times. So, I would simply use short-term insulin while waiting for my new pump as follows: I’d take an injection every four hours, starting at midnight. My dose would include the next four hours of basal insulin, any correction I might need, and dosing for any food I’m planning to eat (I would time my meals for when I was injecting.) This worked well enough, and I didn’t have to worry about having a second insulin on hand, Also, when I did start up my new pump I didn’t have any long-acting insulin on board that I needed to consider.
Work with your pump trainer & doctor for this kit’s inventory. Below is emergency kit inventory & you should plan enough for 30-45 day evacuation. Check contents monthly. . For Rx items, work with doctor & product reps for samples. Attend orientation classes.
BG testing supplies: meter, strips, lancets, batteries, and control solution.
Fast acting carbohydrate to treat low BG.
Extra snack for longer coverage like fast-acting carbohydrates including protein, & fat.
Glucagon emergency kit or equivalent – consider minimum 2-3.
Ketone measurement supplies – if history of elevated ketones or MD advises.
Anti-emetic drug of choice (what you and your pump team believe best).
Anti-nausea and/or other drugs (what you and your pump team believe best).
OTC meds: NSAIDs, triple antibiotic ointment, (what you and your pump team believe best).
Rapid-acting insulin & syringes or insulin pen & needles. (Enough for 30-45 days)
Long-acting insulin & syringes or insulin pen & needles. (Enough for 30-45 days)
Charging gear and/or batteries for 30 - 45 days.
Insulin pump – spare parts (port covers, battery caps, etc.)
CGM sensors . (Enough for 30-45 days) (rotate after acquisition of new supplies)
Spare CGM transmitter , if used (rotate after acquisition of new supplies)
Pump packs – everything you use to change your cartridge & infusion site in a Ziplock® sealable plastic bag (Enough for 30-45 days + 2 extra sets)
a. PODs or infusion set &
b. Insulin pump cartridges
c. Syringe & needle used for cartridge filling
d. Skin prep supplies - alcohol swabs and skin preps
e. Site dressing
f. Tongue blade
Diabetes medical alert identification or jewelry (should be wearing/carrying)
Insurance card(s) – also copy in phone’s photos or electronic wallet or both
Surgical marker or “Sharpie®” pen to mark location of a lost CGM wire, etc.
A list of current medications (both brand & generic names) including dose, schedule and when taken. Your pharmacist can help with this and possibly provide a document to get medications filled away from home in an emergency.
A list of your emergency contacts, including address, telephone, & email.
PROTOCOLS Protocols, plans, or instructions for PUMP FAILURE, SITE FAILURE of the infusion set, HYPERGLYCEMIA, KETONES - measured according to RXer instruction: urine or blood, HYPOGLYCEMIA, SICK DAY or other illness, HORMONE cycles, MEDICATIONS like steroids, pump on & off pump instructions and supplies.
Tape &/or over-patches used to secure pump sites & CGMs
Blade razor or similar to remove hair if needed to prepare a site for pump or CGM.
Power block or other USB power source to recharge pump if electricity is out.
Gauze pads to hold pressure or cover bleeders.
Stain removal pen(s) to remove blood stains from bleeders, etc.
Flashlight with extra batteries.
Leatherman or Gerber multi-tool or equivalent.
Cellphone with charger - know how to use alarm clock & other features.
30. Any other items you & your pump team believe helpful.
Consider a weatherproof case like the Pelican iM2450 Storm Case or the Harbor Freight Apache 4800 Weatherproof Case for egress in hostile weather situations.
RATIONALE: Why 30-45 days. There have been several disasters (floods, wildfires, earthquakes, hurricanes, etc.) or similar events in the recent past in the USA and globally where evacuations and other circumstances have necessitated rapid relocation. This list has been made in consultation with endocrinologists, CDECS, pump trainers, nurses, paramedics, and disaster shelter managers. <<27 Sept 2024 - Hurricane Helene>>
I’ve heard people in different parts of the world call pump vacations different things so if you aren’t sure what we’re talking about…
@Michelle43 an example of waste is pushing single use insulin pens instead of penfills and reusable pens. Me tossing my expired glucagon or Terry and his Tresiba is called being prepared. Back in the R and N days I ran out of N twice when I didn’t have the ability to get more. Terrible awful no good experiences.
@Michelle43 – You make a valid point about pump reliability with respect to the need for any long acting insulin for a backup. I’ve used various pumps, usually in warranty, for 38 years. Warranty replacements usually happened within 24 hours. I can’t remember a time when I needed to switch to a long acting insulin for basal. I don’t think I’ve ever been stuck in that situation.
Having said that, I have experimented with adding a long acting insulin separately to my pump routine and found it a nice benefit in certain situations. Some people call this untethered. I used it for beach vacations when I wanted to disconnect from my pump for a few hours at a time.
My basal insulin need was essentially shared between my pump and a long-acting once daily dose. I aimed for the long-acting shot to cover about 90% of my basal need and the pump to cover 10%. This regimen has the advantage of eliminating the DKA risk caused by pump or absorption failure (kinked cannulas, etc.).
I have had more than one serious DKA threat while wearing a pump. My last one was a kinked cannula that was not discovered until a full night of sleep elapsed. I woke up to a very high BG, 250+, high blood ketones, and sick to my stomach. I’m sure I was on the edge of full blown DKA and a trip to the ER. I was luckily able to avert the DKA with syringe insulin, an infusion set change, and a pump reservoir change. I also drank extra water.
Now I know that adding another required item to the already long list of diabetes daily tasks is not desirable but the advantages of the untethered system is significant. It provides a sense of freedom when you disconnect from the pump for several hours without a hard deadline to reconnect. And for some people, like forgetful teenagers, it can provide crucial safety.
I only used untethered for a short time for trips to Hawaii and some experimental settings back home. Like you, I depend on my ability to be watchful and to take timely countermeasures when needed.
We all must balance diabetes burdens and benefits. There is no right or wrong here except when risks intervene. I am not perfect and have ended up in the ER twice in my 41 years with diabetes.
I have been pumping for 20 years now and have never been off a pump for a single day. I currently use a Tandem tSlim X2 which I started in early 2023. I have several old Medtronic pumps that still work and I keep some supplies for that. Should my Tandem pump fail I will just hook up to my most recent Medtronic pump. If it doesn’t work for some reason I’ll choose another of the older models. I can’t use any kind of auto mode because they don’t work with Dexcom but I’d be fine for 1-3 days or however long it takes for Tandem to send me a replacement pump. I ran all of my Medtronic pumps in manual mode anyway.
I absolutely have long-acting insulin and know how to calculate doses. I take what I call “pump breaks” on purpose to keep my MDI skills sharp. They will fade over time.
I was all set with short and long acting cartridges for my ancient pens for a 4 month vacation. I remember the days when Medtronic would give me a loaner pump. However, I have met (in person!) a fellow T1D and she loaned me her spare pump for my trip. That was very kind of her and definitely gave me peace of mind as I don’t know how I would cope going on long acting insulin again.
I’ve been using a pump for 38+ years. I have not administered long acting insulin since being on a pump. In the years, I have old pumps I can(and do) retrieve and get running if I need a backup.
I have no Basel insulin just the lyumjev I normally use.
In the many years I’ve been pumping, the lack of a backup plan has kind of freaked me out. However, my endocrinologist says I don’t need one. That kind of surprises me. Even though I currently wear a Tandem, I do have an old Medtronic pump along with supplies in my closet, just in case something were to happen to my Tandem. Basically, having type 1 diabetes puts me on life support so I personally feel I need some sort of backup. Besides the spare pump, the only other supplies I have are syringes and Humalog, which would not be the same as having a long acting insulin. Plus I would not know how to dose using that method anymore.
Same situation with me, Liz. I just remembered I have two old Medtronic pumps that don’t have looping capabilities but worked perfectly fine. I’ll just rely on those. They give me peace of mind.
My doctor writes me a prescription that I don’t fill for a long acting insulin. I used to fill the prescription and it would sit in my fridge for a year or three before being thrown away. The prescription is at CVS so presumably I could find somewhere to fill it in most of the US in a fairly timely fashion if need be but I’d have to figure something else out if I was abroad.
I also have several old pumps that still function.
