What do you do if pump malfunctions at night?

[Lizzy731]

We thought we had a problem with Bethany's site 2 nights ago because her correction wasn't bringing her down but we waited it out another 2 hours with good results (she ended up to get sick the next day with a cold). Thank goodness because the alternative was waking her up and changing her site. BUT, I was thinking in the future that I could just give her a shot of lantas and novolog to correct her after deactivating the pump. This would most likely not wake her up and would be less traumatic. I have never used lantas but I was told to add up her basal for the day on the pump and give her that amount in the syringe. However, I was wondering if I could give her half that amount so the lantas wouldn't last as long because I would be putting the pump back on her in the am. Does it work that way? Does anyone do this method instead of waking up a 3 year old to have to do something she absolutely hates?

Thanks everyone.

[miss_behave]

No, it will not work this way. Lantus is a 24 hour insulin. So whatever the dose you inject, it will last approximately 24 hours.

[BrendaK]

Are you talking about the pump itself malfunctioning, or are you talking about a bad site?

If it's a bad site and you don't want to change out the site at night, you give a shot of Novolog every 2 hours, equal to the amount of basal she would be missing. If she gets .25 units/hour, you would give 1/2 unit every 2 hours to replace the basal. (And any extra needed to bring down a high number.)

You would only give Lantus if the pump is totally malfunctioning and it would be a day or 2 before a replacement pump arrives. We had to do this a while ago -- and I did what you said. Give the amount of basal for the day w/Lantus, then give Novolog for meals/snacks like you would normally bolus. Whatever dose of Lantus you give, it works for 24 hours.

BTW -- we've had to change sites in the middle of the night and Carson doesn't usually wake up at all. I'd rather change a site than give shots every 2 hours at night.

[Kaylee's Mommy]

what we have been told to do in the middle of the night is to give keep correcting with novalog.. if its closer to midnight I'd be inclined to actually change out the site.. since she'd be going 9 hours without a background insulin and would develop ketones very easily. but if its in the middle of the night, 3am or so we just correct with novalog.. that would last until 6/7am.. and then we'd either give more novalog and then do a site change when she wakes up (at 9am) or we'd just do the site change then.. Kaylee is so use to site changes now she doesn't want to use emla.. so we just do it and get it over with.. I just let her know that I"m doing it.. she doesn't even wake up.. but when we were new to pumping I wouldn't do the site changes without the emla.. dh always insisted doing it without it at night.. and just not wake her up.. but that really isn't fair to her.. to be woken up getting a site change.. just not a nice way to wake up.. but now that she is so use to it..she never really wakes up (and we do try and avoid site changes in the middle of the night as much as possible.. )

I wouldn't bother with the lantus.. because you'll have to wait until the lantus wears off (well, you could just turn her basal off and use it for coverage and corrections until that lantus wears off..) Idon't think by giving 1/2 the dose it will wear off faster, it just won't work as well.. and you should round down when you use lantus.. like if her basal total was 2.34 units, round down to 2units:)

[nebby3]

If you don't want to do a site change, just give novolog to cover the correction and the missed basal. You will have to give it every 2 hours. Can you do a site change while she is asleep? My dd will usually sleep through them.

[Lindy]

We are Omnipod users too and we have had one bad pod so far, maybe not the pod but bad placement... We did the change at night and he didn't even flinch, it was AWESOME!!! Best pod change ever - in fact we have started to do more of our pod changes at night if we can - so much less traumatic on everyone involved! He is more relaxed and it is a snap - give it a try, don't wake her up, see if she'll sleep thru it.. Good Luck!

[Lizzy731]

Why can't I just give her lantas instead of giving a shot of novolog every 2 hours and do a temp reduced basal when she goes back on the pump in the AM? I can even suspend the basal for 12 hours if I wanted to....it seems that noone does this, but I am curious why not? It just makes sense to me...I would probably check her a few times that night to make sure she wasn't dropping but I would try the lantas route.

I am just curious why noone would go that route?

[Momof4gr8kids]

Why can't I just give her lantas instead of giving a shot of novolog every 2 hours and do a temp reduced basal when she goes back on the pump in the AM? I can even suspend the basal for 12 hours if I wanted to....it seems that noone does this, but I am curious why not? It just makes sense to me...I would probably check her a few times that night to make sure she wasn't dropping but I would try the lantas route.

I am just curious why noone would go that route?

Our pump failed, and we went back to lantus for 24 hours. I really think that was a bad move. Julia ran high the whole time, in the 200s. I am not sure if it wasn't enough insulin or what, but we went from Total basal for the day to that amount of lantus so if anything I expected lows with a scattering mild highs at night. But man, it was like beginning lantus all over again the first few days after dx. I really think that lantus does need to be used for a few days before you see the full effect. You can always try it, and hope it works.

[BrendaK]

Great question -- I would definitely give the lantus if the pump broke and I wouldn't have a new pump for a while. I would not give Lantus at night for a bad site.

Lantus is a totally "flat" acting insulin. It won't bring down a high number like Novolog will.

So technically you could give lantus at night and then give a 0% basal for the next 24 hours, until the Lantus wears off.

But that seems really risky. How will you know exactly when the Lantus wears off? And if your child is on a lower basal rate at night than during the day with the pump -- you can't do that with lantus. You give 1 shot for a 24 hour period and it works the SAME for the whole 24 hours. What if your child needs much less insulin at night than during the day for a basal rate?

Personally I think it takes a lot more work and testing to make the switch from the pump to Lantus like that -- because you don't know how the child will react. Since Lantus is a totally different kind of insulin, it just doesn't always translate exactly like you think it would. That's why so many people have a hard adjustment going from shots to pumping. Does that make sense?

[Lizzy731]

Great question -- I would definitely give the lantus if the pump broke and I wouldn't have a new pump for a while. I would not give Lantus at night for a bad site.

Lantus is a totally "flat" acting insulin. It won't bring down a high number like Novolog will.

So technically you could give lantus at night and then give a 0% basal for the next 24 hours, until the Lantus wears off.

But that seems really risky. How will you know exactly when the Lantus wears off? And if your child is on a lower basal rate at night than during the day with the pump -- you can't do that with lantus. You give 1 shot for a 24 hour period and it works the SAME for the whole 24 hours. What if your child needs much less insulin at night than during the day for a basal rate?

Personally I think it takes a lot more work and testing to make the switch from the pump to Lantus like that -- because you don't know how the child will react. Since Lantus is a totally different kind of insulin, it just doesn't always translate exactly like you think it would. That's why so many people have a hard adjustment going from shots to pumping. Does that make sense?

yes, it makes total sense. Bethany is on the lowest setting of the pump from 3A to 1P, so the lantas would probably bring her down more during these times...so, that's why I said I would give her a more conservative does of lantas and probably end up checking her a few times in the middle of the night. But I guess this is the same as correcting her with novolog every couple of hours. But I thought just for one night, it wouldn't be the worst thing in the world. I think waking her to change her pod WOULD be the worst thing in the world for her. And to me that's most important.

Thanks for everyone's input!