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Mike Hoskins/DiabetesMine

There’s nothing quite like the horror of having an insulin pump suddenly go berserk at 11 o’clock on a Saturday night. The buttons that don’t respond to touch, the shrieking alarms, the “critical error” notifications signaling you must contact customer service. It’s almost enough to induce a panic attack.

Although insulin pumps are the most advanced treatment method of choice for many people with diabetes (PWDs), they aren’t perfect. These technical gadgets are just machines, and they sometimes have glitches or malfunction completely.

Of course, according to Murphy’s Law, an insulin pump will usually die at the most inconvenient moment. That could be just before bedtime or in the middle of the night, while you’re on vacation, or during a busy work conference where you just don’t have time to deal with device woes.

What’s a PWD to do in these situations? We’ve culled the experts and compiled some advice.

The number one piece of advice we heard from healthcare professionals, insulin pump companies, and fellow D-peeps in the community: Don’t panic.

We can sometimes feel as though we can’t live without a piece of technology, especially if our diabetes management has always included that hardware. But know that it is certainly possible to live on and manage blood sugar levels without that tech — especially for a short period of time. Remember that before this tech existed, PWDs managed without it for decades.

To avoid falling into the trap of overreliance on diabetes technology, it’s important that you have a backup plan to revert to injections if necessary. Being prepared will help you avoid panic if and when something goes wrong with your pump. Be sure that you have a vial and syringe or insulin pen in your backup kit at any given time. If you’ve been a pumper for many years — like our team here at DiabetesMine — it’s easy to forget that.

Also, there are several common insulin pump problems — as well as issues with continuous glucose monitors (CGMs) — that you can troubleshoot on your own, including “occlusion errors” (blocked cannula) and snagged tubing. See our DiabetesMine guide to Troubleshooting Tips for Common Insulin Pump and CGM Problems.

If you’re sure your pump is kaput, and you do need to call the manufacturer for help, just be aware that not every diabetes device company has 24/7 customer service. Some only operate during regular weekday hours, or limit hours on weekends.

(See the paragraphs above about Not Panicking and biding your time until you can get a replacement device.)

Once upon a time, PWDs using insulin pumps were sometimes given two devices, so they’d always have a backup if one broke. Today, with more advanced technology and tighter budgets, that is no longer the case.

But some of the insulin pump makers still offer a travel loaner option, which allows you to borrow an extra pump for a modest fee for a limited time.

All of the companies now have fairly cut-and-dry recommendations for what you should do if your insulin pump suddenly becomes a very expensive paperweight.

This usually involves contacting a call center, where a representative will take down your product and customer information for their database, and walk you through a step-by-step troubleshooting process to see if they can fix the problem first, without needing to send a new device.

If it’s determined that you do need a replacement, the units are generally sent by overnight shipment or second-day delivery, meaning you’ll be up and running again very soon. If you worked with a local rep to get set up on your pump initially and still have that person’s contact information, feel free to reach out. Those regional reps can sometimes help out even more immediately by dropping off a new unit to you in case of emergency.

Here are the specifics of what the existing pump companies in the United States tell their customers to do in case of trouble:

Medtronic Minimed

Medtronic offers 24/7 technical support, 365 days a year.

To make an inquiry specifically regarding replacing a Medtronic pump, they direct customers to contact their Diabetes Therapy Consultant Team at 800-646-4633 and press 3. That team is available Monday through Friday, 8 a.m. to 7 p.m. Central Time.

Depending on the type of device, they’ll send a prepaid shipping label or a FedEx box with a label for returning the broken unit.

They do have a travel loaner program that allows U.S.-based customers to borrow a backup insulin pump for a fee of $50 fee every 90 days. This applies to customers who may go on a cruise, travel to Hawaii or Alaska, or travel internationally. (The program only includes insulin pumps and does not include their CGM devices.)

To apply, customers must complete their travel loaner form and submit it at least 2 weeks prior to their trip to ensure on-time delivery. A signature is required upon delivery, and you’ill need to return the travel loaner when you arrive back home.

Insulet’s Omnipod

Insulet has an online form to let users of this tubeless pump report issues and connect with a customer care or tech support rep to discuss options.

Should one of the insulin-containing disposable pods malfunction, users can request a replacement. They’ll be sent a special package to ship the faulty pod back to the company.

Insulet tells patients that if their Personal Diabetes Manager (PDM) — the system’s controller unit — breaks during the 4-year warranty period due to a defect in materials or workmanship, it will also replace that device at no charge. There are some conditions and exclusions, however, detailed in the device user guide. Insulet notes that in most cases, replacements are sent out within 24 hours.

“Loaners are offered subject to availability,” and users should contact their customer care team for more information, they state.

The company’s U.S. Customer Care Team can be reached by calling 800-591-3455 and selecting option 2 for assistance. They are open for business 24/7, year-round.

Note that some replacement policies may change as Insulet launches its next-generation model, the Omnipod 5, later in 2021, as that system will connect directly to a smartphone without the need for a separate PDM device.

Tandem’s t:slim X2

Tandem Diabetes Care also offers customer and tech support 24/7 every day of the year. That team can be reached at 877-801-6901.

Pumpers are directed to contact that support line to start the replacement process if necessary. They note, for example, that if a t:slim X2 touchscreen is cracked or broken, that too is covered under the terms of the limited 4-year warranty under normal conditions of use.

Tandem has an entire FAQ online with specific instructions for setting up a new replacement pump and connecting it to a CGM, as well as to their t:connect data platform.

On top of that, once users receive a replacement device, Tandem directs them to a series of training videos posted publicly to assist programming your new t:slim X2 with settings.

Tandem does offer short-term loaner devices for traveling at no cost, but they are very specific about handling of the loaner pump. It must be returned either unopened or with an accompanying “authorized return number,” set up in advance with customer support. “If opened without the appropriate Customer Contact case and authorized return number, you will be charged for the replacement,” they state.

Roche Accu-Chek

Even though Roche Diabetes Care stopped selling its Accu-Chek brand of insulin pump in the United States back in 2017, the company is still supporting some legacy customers using those devices. Users can check out their landing page with detail on in-warranty pumps.

Roche states, “During the warranty period, Roche Diabetes Care will repair or replace, in its sole discretion, any insulin pump that does not work properly because of a defect in materials or workmanship… This warranty applies only to new devices. In the event a pump is repaired or replaced, the warranty period will not be extended.”

Mainly they are now working to pass users on to another brand of pump.

If you have questions, the Accu-Chek customer care can be reached at 800-688-4578, during weekdays from 8 a.m. to 8 p.m. Eastern Time. You can also check out their online hub for customer support.

It can be a bit concerning when device recalls make the headlines, especially if the particular pump model that’s supposed to keep you alive is the subject.

The Food and Drug Administration (FDA) keeps a comprehensive database of safety notices, and according to an Associated Press analysis of that database from 2008 to 2018, insulin pumps and their components are collectively responsible for the highest overall number of malfunctions, injury and death reports.

Yikes, that certainly sounds scary.

But the FDA database can be difficult to navigate and even a bit misleading if searched without the proper context.

During an investigation of the database a few years ago, then-director of the FDA’s division of chemistry and toxicology devices Dr. Courtney Lias told DiabetesMine: “You can’t just look at the number of recalls and make conclusions based on those numbers alone… You have to take into context what the recall was, how it was found, and what else was going on with the company at the time. That’s hard to do from the outside because you don’t have those conversations and context all the time.”

In addition, this 2015 study from a team of researchers in Australia and New Zealand found that 40 percent of insulin pump users experienced problems, with a minority, particularly in children, requiring hospital management.

Nevertheless, those researchers and others across the board are quick to point out that even with pump failures and recalls factored in, insulin pumps are safe and often result in better outcomes than using traditional insulin injections.

As mentioned, it’s critical to be prepared to fall back on using syringes or an insulin pen in case of a no-tech emergency.

This means you should always have a vial or pen of basal (long-acting) insulin on hand along with the rapid-acting insulin you usually use to fill your pump. In case you’ve forgotten, long-acting insulin brands in the United States include Lantus, Toujeo, Basaglar (all glargine formulations), Levemir, and Tresiba. Unopened bottles and pens can last for months if they are kept refrigerated.

No extra insulin on hand to use for injections? In a pinch, older versions of “human” insulins like NPH sold at Walmart can be an option because they’re more affordable, but be careful because those older formulations are much less reliable. And dosing isn’t calculated the same as newer insulins, so it’s always best to talk to your doctor or diabetes care specialist before turning to those.

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It’s also important to have your current insulin pump settings recorded somewhere handy. Those settings — including insulin sensitivity factor, carb-to-insulin ratio, basal rates, and total daily dose amounts — will be critical to setting up your replacement pump when you get it. They may also be important to help calculate how much insulin you might need while going back on injections.

No idea how much basal insulin to inject now, without your pump? Contact your doctor or diabetes care specialist for assistance. There is also credible guidance posted online that can help.

Remember that switching from your insulin pump’s basal profile (constant drip) to long-acting insulin injections isn’t an exact science. Diabetes care and education specialist (DCES) Gary Scheiner at Integrated Diabetes Services in Pennsylvania, who lives with type 1 diabetes himself, has this advice:

“If you don’t have a backup pump, it is necessary to take long-acting insulin immediately. If your basal program has a significant peak/valley, NPH might be your best option. If not, glargine is usually best. If using NPH, take 80 percent of your total pump basal insulin as a single shot of NPH. If using glargine, take 110 percent of your total pump basal as a single shot.”

When UPS or FedEx does arrive with your brand-spanking-new insulin pump, don’t get too excited. Long-acting insulin stays in your system for many, many hours. “Remember to let the long-acting insulin wear off before resuming basal delivery with your new pump,” Scheiner says. “Wait at least 12 to 14 hours after taking NPH, and 20 hours after taking glargine.”

PWDs are increasingly using so-called “closed loop” systems that connect a CGM with an insulin pump to optimize diabetes control. Medtronic is the only company that actually makes both devices and sells them coupled in one system. The newest commercial closed loop system is from Tandem Diabetes Care, but that connects the Tandem t:slim pump with a Dexcom CGM — so two different manufacturers are providing support.

In these connected systems, sometimes a fussy CGM sensor or transmitter can lead to hiccups that make one’s insulin pump experience less productive.

How are these companies handling this customer support crossover? Dexcom and Tandem tell DiabetesMine that reps at both companies are well prepared to talk callers through the process of determining whether any problems lie with the pump or CGM, and then directing customers accordingly.

There is also the ever-evolving do-it-yourself (DIY) community, where the #WeAreNotWaiting mantra has brought thousands of people into the fold using homemade connected systems with different devices.

These DIY tools are open source, community-made mobile apps and platforms that don’t have traditional company-provided customer service or tech support.

Instead, users must turn to online forums and groups to get questions answered. The Looping community has actually created an amazing set of open source documents to support patients using that system, known as LoopDocs.

The trouble is that many of these systems are built using older, out-of-warranty pumps from Medtronic. If one of those dies, you’re basically on your own finding a replacement. The other current option is to build your homemade Loop system using the OmniPod pump, in which case you can turn to the manufacturer Insulet if the pump has issues, although the company cannot provide any additional support on your Loop system.