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What to do if your insulin pump stops working

If ketones are present (0.6mmol/L or higher), refer to hyperglycaemia and ketone advice

Failure to deliver insulin could be due to:

• Pump malfunction
• Flat battery
• Empty cartridge
• Running out of pump supplies

For pump malfunction contact the pump company.

Customer service numbers

Medtronic:1800 777 808

AMSL Diabetes (Tandem T Slim):Ìý1300 851 056

YpsoMed: 1800 447 042

You must revert to injected rapid acting insulin until pump delivery is recommenced.

Injected insulin dose

• Divide your pump total daily dose (PTDD) by 6 (PTDD ÷ 6) and administer this dose as rapid acting (NovoRapid® or Humalog®) insulin every 4 hours.
  
• Eat 30 grams of carbohydrate with each injection of rapid acting insulin.
• If you are awaiting a replacement pump, consider changing to rapid acting insulin with meals and once daily long acting insulin (multiple daily injections). See the information below.Ìý

Be prepared – all families on pump therapy should ensure they have:

• Upload your insulin pump weekly or ensure that the pump is set up to do automatic uploadsÌýÌý
• Have rapid acting insulin pens - Novorapid® or Humalog® penfill cartridges or disposable pens
• Pen needle tips
• A prescription (in date) for long-acting insulin (i.e. glargine/Optisulin®)
• A plan of how to calculate doses if you need to revert back to injectionsÌý

Remember know your pump total daily dose (PTDD)!Ìý

If you pump malfunctions you will not be able to retrieve this information from the pump. It is important to:

• For Tandem T:Slim upload your pump weekly and have a copy of the settings page including the page with your PTDD available so that you have all of the needed settings availableÌý
• For Ypso insulin pumps. Your upload will automatically be on Glooko, it is important you can access these settings. It is important to know your username and password for Glooko.Ìý
• For Medtronic pumps, your pump will upload automatically if you are linked to the app. Ensure you know your CareLink username and password. If you do not have your pump linked to the app, you need to manually upload it weekly with the USB andÌýhave a copy of the settings page including the page with your PTDD available so that you have all of the needed settings availableÌý
• Know how to access your online information – contact your pump company if you forget your login details, or have difficulty accessing the upload website (CareLink® or Glooko®)Ìý

Changing back to multiple daily injections while waiting for a replacementÌýpump

If yourÌýpumpÌýhas malfunctioned or needs replacement e.g. due to cracked screen, you will need to give insulin injections until you have a new pump set up.Ìý

Key tips

• The information below explains how to work out doses for both long acting (basal insulin e.g. glargine/Optisulin®) and rapid acting (bolus insulin e.g. NovoRapid®Ìýor Humalog®).Ìý
• A replacement pump can take a few days to arrive. ÌýÌý
• Ideally, you should know yourÌýPumpÌýTotal Daily Dose (PTDD),Ìýhowever if you don't, you can assume it is the same as your body weight (e.g. weight 30 kg, assume PTDD = 30 units)
• If you are using CGM and the reading is less than 4.0 mmol/L or 15 mmol/L or higher check your fingerprick blood glucose level (BGL). Remember to check for ketones if the glucose is 15 mmol/L or higher -Ìýsee ketone treatment guidelines if ketones 1.0 or higher (as you are now on injections ketones need to be managed when 1.0 mmol/L or higher)Ìý
• What ever option you follow, you will need closer glucose monitoring including checking overnight. If you use continuous glucose monitoring (CGM) connected to yourÌýpumpÌýand you cannot access your CGM on a smart phone, remember to regularly check your BGLs 4 - 6 x per day.Ìý
• On injections, hypoglycaemia management requires both quick acting and slow acting carbohydrates to manage the low glucose level

Basal insulin

Give 40% of your PTDD as glargine (e.g. if your PTDD is 50 units, 40% = 20 units glargine).Ìý

• Glargine works for 24 hours and should beÌýgiven at the same time each day.Ìý
• When you restart yourÌýpump, consider starting the pump when glargine is no longer working in the body (24 hours from when you gave glargine).Ìý
  Other options to re start the pump when glargine is still working in the body is to:Ìý
  - Tandem:ÌýExercise Activity ModeÌýuntil glargine is not working in the body
  - Ypso: Use Ease off mode or re-start the pump when glargine is not working in your body anymoreÌý
  - Medtronic: requires 48 hours in Manual Mode with the new pump until Automode can be re-started and use a temporary basal rate at 0% until glargine is not working in the body anymore (this ensure basal insulin isn't doubling up with your injected insulin in your bodyÌý

Bolus insulin

• You'll need to give NovoRapid insulin with your main meals.Ìý
• Option 1 below assumes you know your insulinÌýpumpÌýsettings, including carb ratio and sensitivity/correction factor. If you do not have access to these settings, follow Option 2.

Option 1Ìý

A. To work out your insulin for foodÌýbased on your current carbohydrate ratios.Ìý

• Find your carbohydrate ratio in your pump settingsÌýÌý
• Divide the amount of carbohydrate to be eaten by your carbohydrate ratio settingÌý

Example:
I am eating 60 grams of carbohydrate and my carb ratio setting is 10 grams
60Ìý÷ 10 = 6Ìý
Give 6 units of rapid acting insulin before eating

B. To work out your insulin for correctionsÌýbased on your current insulin sensitivity/correction factors.

*We will use correction factor for the remainder of this page. This may be called sensitivity factor in your insulinÌýpump. It means the same.

We advise to only correct above target glucose levels before meals using your current glucose level.Ìý

If you are wanting to give a correction after meal time insulin, wait at least 3 hours after your meal time rapid acting injection and closely monitor your glucose levels following this dose e.g. by doing a fingerprick BGL 2 hours after this dose or by monitoring on your CGM

You need to know your 'target glucose' for corrections. We will use a target glucose of 6 mmol/L

The correction factor is an estimation of how many mmol/L 1 unit of insulin will lower your glucose

Calculating your rapid acting insulin for correction

There are a few ways to know how much insulin you need to help your glucose levels come down to the target range. The amount of insulin to give is based on what we call aÌýcorrection factorÌý(also called insulin sensitivity factor).

We describe it as: 1 unit of insulin will lower your glucose by ‘X’ number of mmol/L,Ìýwhere ‘X’ is the correction factor.

Step 1:ÌýTake your PTDD

Step 2:ÌýCalculate your correction factor =Ìý120 ÷ your PTDD OR take your current correction factor from your pump uploadÌý

Step 3:ÌýWork out the correction dose (the amount of extra insulin needed to bring your glucose level back into range). This amount will vary, depending on your current glucose level and your correction factor.Ìý

• Go to thisÌýÌýto work out how much need to correct. If you do not have a carb ratio just keep this blank and fill in yourÌýCorrection/ISF and Current BG and it will do the calculation for you.
• To do this calculation manually go through the following:Ìý

This is how you work out how much insulin you need at this time:ÌýÌý

A.ÌýCalculate the correction gap to be treated: Current blood glucose level - Target glucose level (use 6 mmol/L) =

B.ÌýCalculate your insulin correction amount by dividing your correction amount (worked out in A) by your correction factor (Worked out in Step 2 above)

Correction amountÌý÷ correction factor = correction dose to be given

C.ÌýAdd the ‘correction dose’ amount to your usual mealtime insulin dose (i.e. the dose that will cover food).

Example of working out the insulin you need for a correction

My current glucose is 13.8 mmol/L before lunch. I am targetting my glucose to come down to 6 mmol/L. In my pump my current correction factor is 5.5 mmol/L/Ìý

A. 18.8 (my current glucose level) - 6 mmol/L = 7.8 mmol/L is the gap my glucose level needs to come down to targetÌý

B. 7.8 mmol/L ÷ 5.5 mmol/L (current correction factor) = 1.4 units of rapid acting insulin

If you have a half unit rapid acting pen you would round this dose to 1.5 additional units of rapid acting insulin but if you don't you would add an additiona 1 unit of rapid acting insulin to your lunch time dose.ÌýÌý

Then, calculating your bolus dose for food and corrections: from the example above, 6 units of rapid acting insulin will be given for the 60 grams of carbohydrate and 1.5 or 1 units for the correction = 7 or 7.5 unitsÌý

Option 2

Working out your bolus insulin if you do not know yourÌýpumpÌýbolus settings

Give 20% of your PTDD as rapid acting insulin with breakfast, lunch and dinner – i.e. three meals will give 60% of daily insulin as bolus insulin and 40% as basal (glargine/Optisulin®) insulin.

e.g. if the PTDD is 50 units, 20% of 50 units = 10 units. Give 10 units rapid acting insulin (Novorapid® orHumalog®) with meals and 20 units glargine once daily.ÌýÌý

You may need to adjust this dose by 10–20% e.g. 1–2 units if you are eating more or less carbohydrate than usual. Generally aim for a minimum of 30 grams of carbohydrate to be eaten with each meal.

You may need to adjust the long acting dose by 10% each day if you are having higher or lower glucose readings overnight or on waking.

Dose adjustment guide for injections

Page updated September 2024Ìý