Plan Preparation

1. First and foremost it is important to understand the necessity of having a backup plan to deliver insulin if your pump fails.  It is an urgent matter and must be taken seriously.
2. Discuss your requirements with your Health Care Professional.  Obtain prescriptions for your insulin requirements from the Doctor.  Most Physicians will suggest staying on your current rapid acting insulin and administering every 4 hours around the clock.  Others may suggest using long acting insulin for the basal portion of your Total Daily Dose (TDD).
3. Ascertain your insulin requirements with your Doctor for whatever insulin regime is chosen.  There is a nice table that provides guidance on this subject in Pumping Insulin, Fourth Edition, Table 9.11 that is worthy of review.
4. Decide on what you want to use as a delivery system – pens, syringes.  Assemble the required supplies for MDI, e.g. alcohol swabs,syringes, pens.
5. Develop the scenarios to cover all situations, i.e. how long will you be off the pump, will you be away from home, how close are you to health support, etc.  Incorporate these variables in your plan.

Implementing the Plan:

1. Call the pump manufacture to diagnose the problem and to initiate a replacement unit.

2. Get prescriptions filled immediately NovoRapid / Humalog cartridges (pen) or vials (syringes). Know where the 24 hr. pharmacies are located.

3. Try to determine how much insulin you have on board. Then give NovoRapid / Humalog /Apidra every 4 hours around the clock; add your basal rate and any bolus insulin requirement for food.

For example, to determine the amount of insulin to cover the 4 hour period from 08:00 AM to 12:00 Noon, given that your basal rates are as follows and your Insulin to COH ratio is 1u:10g and you consume 45 grams of COH for breakfast:

4. Have a good alarm clock!

5. Initially take BG’s every 2 hours until you are sure that you have good control and the BG readings make sense.