Insulin Pump Failure Protocol

If your insulin pump fails, it is important to follow a specific protocol in order to ensure that your blood sugar levels remain stable. This protocol assumes your insulin pump is no longer functional even after troubleshooting (calling the pump company or your physician’s office for guidance) includes the following steps:

How to calculate a correction

A correction factor or insulin sensitivity factor, allows you to correct a high blood glucose. It should be administered every 4 hours as and when needed (blood glucose above target) 

When calculating a correction bolus using an insulin correction factor, the first step is to determine the current blood sugar level. Once the current blood sugar level is known, the next step is to find the target blood sugar level. The target blood sugar level is usually determined by a healthcare professional.

Once the target blood sugar level is known, the next step is to find the difference between the current blood sugar level and the target blood sugar level. The next step is to find the correct bolus dose by dividing the difference by your sensitivity/correction factor (also, determined by your health care provider) 

  • A correction injection can be given every four hours if needed.
  • Current blood glucose level minus blood glucose target equals Difference
  • Difference ÷ Sensitivity/correction = Correction insulin needed

Example: 220 mg/dL – 120 mg/dL = 100 mg/dL

Example: 100 mg/dL ÷ 50 (sensitivity/correction) = 2 units needed for a correction

How to calculate insulin needed for carbs

Use your carbohydrate ratio (also known as the insulin to carb ratio or carb ratio) whenever you’re eating.  To calculate your bolus, you need to know your carbohydrate ratio. This is the number of grams of carbohydrates that 1 unit of insulin will cover.

For example, if your carbohydrate ratio is 10:1, that means 1 unit of insulin will cover 10 grams of carbohydrates. To calculate your bolus, start by calculating the number of grams of carbohydrates in your meal. If you’re eating a meal with 30 grams of carbohydrates, and your carbohydrate ratio is 10:1, you would need to bolus 3 units of insulin. Remember to always check your blood sugar after meals to make sure your bolus was effective in keeping your blood sugar under control.

Carbs consumed divided by insulin to carb ratio equals insulin bolus needed for carbs

Example: Your insulin to carb ratio is 15

45 grams of carbs consumed ÷ 15 = 3 unit insulin bolus needed for carbs

Calculating your basal rate for 4 hours

If you have long-lasting insulin, skip this step and use the suggested total daily dose of long-lasting insulin prescribed by a physician.

If you do not have “long-lasting insulin” (basaglar, Glargine, Lantus, Semglee,  or TresibaToujeo insulin, etc), you’ll need to improvise with your fast-acting insulin. 

Calculate the amount needed every four hours when injecting fast-acting insulin insulin.

Because the usual duration of action of “fast-acting insulin” is 3-4 hours, you will need to calculate the basal rates for the next 3-4 hours.  Duration of action is how long insulin works.  The following is an example using a duration of action of 4 hours (basal settings in the insulin pump):

The total insulin you will need to give to cover correction, carb bolus and the basal rate is based on your own rates (provided by your healthcare provider)

Example:  8 AM basal rate is 0.5 units/hour                    0.5

Example: 9 AM basal rate is 0.5 units/ hour                    0.5

Example: 10 AM basal rate is 0.7 units/hour                   0.7

Example: 11 AM basal rate is 0.8 units/hour                   0.8

2.5 units Example

Add the 4 basal rates to determine the amount of insulin you will need for basal coverage for the next 4 hours, which will be 2.5 units

Total insulin required per example:

2 units for correction + 3 units for carb bolus + 2.5 units for basal rate = 7.5 units

DO NOT use example rates
Use your own rates found on your most recent pump download, given to you at your last appointment an endocrinologist/diabetes provider.

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About the Author MyEndoConsult

The MyEndoconsult Team. A group of physicians dedicated to endocrinology and internal medicine education.

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