Guidelines for Temporary Removal of the Insulin Pump

Important advice if you need to remove your child's insuline pump.

Why remove your pump?

the pump is broken and a new one won’t arrive for a few days
the pump is lost or stolen
you need to be admitted to the hospital and will be unable to operate your pump
you want to take a “pump break” ( eg. while at the beach)

When off the pump, it is best to stick as close as possible to a “basal-bolus” routine. The following are guidelines only for calculating an insulin dose. Extra blood sugar testing will be needed including overnight, to assess how it’s working for you or your child. Please let your doctor or nurse know when you need to go back on injections, so that we can help you with the “fine-tuning”. These guidelines are dependent on your knowing your pump’s settings, ie. basal rates, meal bolus ratio’s, and correction factors (insulin sensitivity factors).

ALWAYS KEEP RECORDS OF YOUR CURRENT PUMP SETTINGS. Insulin pumps are machines that can break or malfunction. Don’t rely on your doctor or nurse to have all your data up-to-date.

1- Short term off pump (less than 24 hrs): Rapid-acting insulin (Novorapid or Humalog) will need to be given approximately every 3 – 4 hours.

Combine:

3 - 4 hours of basal insulin
a pre-meal bolus for carbs
a correction bolus if needed

Example:

At 8:00 a.m. – the blood sugar reading is 14.8

breakfast is 40 grams
carb ratio is 1/15g
correction factor (insulin sensitivity factor) is 4.0
the basal rate is 0.60 units/hr until noon
4 hours of basal: 4 X 0.60 = 2.4 units
breakfast food bolus: 40/15 = 2.7 units
correction bolus: 14.8 – 6.0/4.0 = 2.2 units

Total dose: 2.4 + 2.7 + 2.2 = 7.3 units, rounded off to 7.0

2- Long term off pump (24 hrs or more): There are 3 options

Give long-acting insulin (Lantus or Levemir) as basal, and rapid insulin for boluses
Give intermediate-acting insulin (NPH or N) ** call the doctor on-call for this dose
Give rapid-acting insulin every 4 hours including overnight, as per the “short term” example

Using Lantus or Levemir

Calculate the total daily basal amount of insulin and give as a single dose of Lantus or Levemir. It can be given as soon as convenient. Then continue every 24 hours thereafter.

Note:

These insulins cannot be mixed with other insulins in a syringe
Take rapid insulin for meal, snack and correction boluses
The carb ratio’s and correction factors remain the same as for the pump
Children who are too young to give their own insulin may need to have a parent go to school to give the lunchtime dose.

Example:

The basal rate is 0.50 units from midnight to 6:00 a.m., and 0.40 units for the rest of the day until midnight. The total basal is 10.2 units. The dose of Lantus or Levemir will be rounded off to 10.0 units, given once every 24 hours until the insulin pump is resumed.

Note:

Since Lantus and Levemir are basal insulins, you cannot have a basal rate running when you restart the pump or severe hypoglycemia may result!
Restart your basal approximately 18 hours after the last Levemir dose; 22 hours after the last Lantus dose.
If you want to re-start the pump earlier, set the basal rate at 0.00 units/hr until all the Lantus or Levemir has worn off.

Important things to remember:

Extra blood sugar checks will be needed to see how your adjustments are working, especially after the first injection of Lantus or Levemir.
Insulin may need to be decreased for activity
Check for ketones when the blood sugar is over 15.0
Be sure to double-check all the settings on the pump and the battery before reconnecting.
Always keep an unopened vial of long-acting or intermediate-acting insulin at home, and take it with you when travelling.

03-01-07 The Montreal Children's Hospital