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Backup system for insulin pump therapy

The insulin pump’s user must have a backup method ready, in other words, doses for multiple daily injections (MDI) therapy as well as the relevant equipment which can be used, if necessary.

If there is an issue or interruption with the insulin pump or its dosage delivery, a backup system is needed. In practice, when transitioning to MDI, the dose according to the pump's basal insulin program is increased by 20 percent. The doses of basal and bolus insulin are adjusted based on readings from a glucose sensor or self-monitoring of blood glucose.


The daily basal insulin dose according to the basal insulin rate is 20 units in total. When switching to MDI therapy, the dosage is 24 units of long-acting insulin. The most suitable basal insulin for the backup method is insulin detemir, which is administered approximately every 12 hours. The total dose is divided in two: 12 + 12 units.

Changing in practice

If you change to long-acting insulin in the morning before noon, you can take the whole morning dose. If you change between noon and 18:00, you can take half of the morning dose. If you change after 18:00, you can take the whole evening dose.

Because it takes long-acting basal insulin 2–3 hours before it begins to act, you should take an initial dose of 1–2 units of rapid-acting insulin to offset the delay.

Take mealtime insulin and, if necessary, correction insulin using an insulin pen subject to the same ratios as in pump therapy.

Updated 4.11.2023