As an insulin pumper, are you prepared for unexpected (or expected) events? For instance, there might be a time when you are not using your insulin pump—either by choice or by necessity. Is this a time for panic?
For starters, do any of the following situations sound familiar?
- You want to be off the pump for part of the day or evening.
- You plan to wear a slinky dress to a social event, but no matter where you try to place the pump, nothing is suitable.
- You’re worried about your pump getting in the way during “intimate moments.”
- You love playing contact sports—football, soccer or scholastic wrestling.
- Your pump has stopped working, and you don’t have another one to re-place it until the manufacturer sends a new one.
- Your pump has been stolen.
- When you went to the circus, it fell out of your pocket and an elephant stepped on it.
These are problems to solve. Who do you call? What is your alternative plan?
The Contingency Plan
A contingency plan—a “Plan B”—is sometimes a necessity when you wear an insulin pump. Here are a few issues you’ll need to consider:
- How long will you be off the pump—hours or days?
- Which insulin or combination of insulins should you take?
- How much insulin do you need, and at what intervals should it be taken?
- What amount will you need for meals? For snacks? For high blood glucose?
- How frequently should you test blood-glucose levels?
- What will you do to maintain blood-glucose control?
Your first priority, above everything else: You need insulin!
*The chart on page 82 provides some basic guidelines. It assumes that you are using a rapid-acting insulin—either Humalog (insulin lispro) or NovoLog (insulin aspart)—for basal and bolus insulin amounts.
You might choose to use longer-acting insulin for basal insulin replacement when you are off the pump for longer than a day, with Humalog or NovoLog used to cover food and to correct high blood-glucose levels.
It is essential to replace the missing insulin by injection as soon as possible, especially for people with type 1 diabetes. Remember that the pump delivered only rapid-acting or short-acting insulin to your body. Within one to two hours of missing the basal dose, and within two to four hours from your last meal bolus, your blood-glucose level will rise above the target range. There is no long-acting insulin hanging around to protect you from developing ketosis. Check for ketones whenever you are off the pump and your blood glucose is over 240 mg/dl.
What is the best way to get insulin when the pump is not delivering it? “Plan B” always involves injections, using either a syringe or an insulin pen. While pen injectors are easier to carry than a vial of insulin and several syringes, you can use either method.
Involve Your Diabetes Management Team
The best plan is one you discuss with your diabetes management team. You’ll need to discuss your options with your physician. In addition, your diabetes educator, nurse practitioner or physician’s assistant might be able to give you guidelines, approved by your physician.
Most physicians experienced with insulin pump therapy can give you the information you will need. Usually they will provide instructions when you have your pump training sessions.
Perhaps these guidelines were part of your training materials, but it might have been some time ago and you have no idea where to find the information. Call your physician for directions. Guidelines need to be individualized and current, and prescriptions need to be written.
Play It Cool
Avoid panic and anxiety. Be confident. Stay in charge. Knowing that you have a back-up plan for times when you’re off the pump can help to give you confidence for handling most insulin pump challenges.