Insulin Pump: What to Know Before You Disconnect
Plus, Tips on Traveling with an Insulin Pump and Using a Pump at School
Many infusion sets have a “disconnect” feature that allows you to temporarily unhook the pump and tubing for situations such as bathing, sports, swimming, intimacy, and when undergoing medical tests (such as x-rays, computed tomography (CT scans), or magnetic resonance imaging (MRI)).
Your diabetes care team will guide you on what to do when you need to disconnect from an insulin pump. You may need to check your blood sugar levels before, during, and after disconnection.
When you use an insulin pump, there is only short acting insulin infused in the pump. Once you're disconnected from the pump, you need to be extra careful and monitor your blood sugars many times during that period of time. This is so that you can detect unusually high blood glucose and avoid diabetes ketoacidosis (DKA), which can happen if there is prolonged insulin infusion interruption.
DKA is a serious condition caused by high levels of acids in the blood called ketones. When the body doesn’t have enough insulin, it breaks down fat to use as energy, which produces ketones. Instances when DKA can develop: you forget to reconnect the insulin pump after exercising or showering, or the catheter is pulled out without your realizing it, your pump reservoir ran out of insulin, or your pump stops working suddenly.
If basal insulin delivery is interrupted for more than one hour, check your blood sugar level and if your blood glucose levels are elevated, check also ketones level (using a simple urine test strip). Also, you should check your urine ketone levels if you have one or more high glucose reading despite taking an insulin bolus to correct the high blood sugar. Call your health care provider immediately if your ketone level is high.
If you are hospitalized, you may be able to continue on your insulin pump, but this depends on the hospital policies and the seriousness of your condition at the time of the hospitalization. Make sure to wear a medical ID bracelet or necklace and alert staff that you have diabetes. If you need surgery, your pump may need to be disconnected and you may need to receive insulin by injection or infusion.
Traveling With an Insulin Pump
When traveling with an insulin pump, bring extra supplies including extra reservoir cartridges, infusion sets, batteries, tapes and adhesives, emergency glucagon with a prescription, food and/or glucose tabs/gel, and insulin vials/pens and syringes in case your pump is not working properly. You may consider taking a loaner pump from your device’s manufacturer as a backup. Carry all of your insulin pump supplies in your carry-on luggage in case your bag is lost and so that the insulin is not exposed to temperature changes in the baggage compartment. Carry your pump emergency card (given by most pump manufacturers), which gives treatment recommendations if something should happen to you.
Notify airport security that you have diabetes and are carrying insulin supplies with you. Insulin pumps, syringes, and other supplies must be accompanied by insulin that is clearly identified with a prescription or pharmaceutical label on it. You are also allowed to bring ice or ice packs to keep the insulin cool. Use Sharps disposal containers for storing used syringes and test strips.
Do not put the insulin pump or continuous glucose monitor through an x-ray machine as the radiation can harm it and do not wear it through an airport body scanner. Instead, you can ask airport security to hand-check your pump, or you can wear an insulin pump through an airport metal detector.
Because rules may change, always check with the Transportation Security Administration before you travel.
Using an Insulin Pump at School
Insulin pumps can effectively be used at school with close teamwork by the child, parents, school nurses, teachers, and healthcare provider.
The American Diabetes Association recommends the three following care plans:
- Diabetes Medical Management Plan —This plan describes how a child’s diabetes should be managed at school and typically includes information on the following:
- blood glucose checks
- your child’s usual symptoms of hypoglycemia/hyperglycemia
- insulin therapy
- snacks and meals
- where to contact you
- emergency plans for hypoglycemia and hyperglycemia
- Section 504 Plan —This agreement is designed to make sure that a child with diabetes is medically safe while at school, has the same access to education, and is not discriminated against.
- Individualized Education Program (IEP) —Children who qualify for services under the Individuals with Disabilities Education Act should have an IEP in place rather than a 504 plan. This plan is more specific than a 504 Plan, and defines what the school will do to meet a child’s individual education needs.
Work with your child and the school to decide where your child will test blood sugar levels, where bolus doses should be given, and where infusion set changes (if necessary) should take place. It may be easiest to let your child check blood sugar levels and make changes to insulin doses wherever they are during the day (classroom, lunchroom, gymnasium, etc.) to help make diabetes care a regular part of the day and prevent delays in treating high or low blood sugar levels. Extra supplies should be left at school, typically in the nurse’s office.
Teenagers and college students may benefit from pump therapy given the stress, varied school and sleep schedule, and changes in food choices that come at these ages. College students should tell health services that they use an insulin pump and give them information about their overall diabetes management plan and health care providers numbers to make health services a part of their overall diabetes care team.