dromlakhani Assess ability to troubleshoot insulin pump malfunction
STEP 1 — Gather Information
Collect pump model and age, recent alarm/error log history, patient‑reported steps taken during past malfunctions, dexterity, vision, and cognition status, infusion site condition, availability of emergency supplies (syringes, backup insulin), and if applicable, bolus calculator settings (insulin‑to‑carb ratio, sensitivity factor, glucose target, active insulin time).
STEP 2 — Rule In / Rule Out
Determine whether the patient can independently identify and correct common pump problems (e.g., clear occlusion, replace battery, acknowledge and resolve error codes) versus requiring caregiver assistance or being unable to act.
STEP 3 — Classify or Stratify
Classify troubleshooting proficiency as: Independent (patient resolves issues alone), Assisted (patient identifies problem but needs help to fix), or Unable (patient does not recognize or act on alarms). Stratify by frequency of unresolved alarms and reliance on others for resolution.
STEP 4 — Decide
If Independent: reinforce current education and schedule routine check‑ins. If Assisted: provide targeted, hands‑on training on specific failure modes and consider involving a designated caregiver. If Unable: arrange comprehensive re‑education with a diabetes educator, simplify the regimen (e.g., semi‑automatic mode or temporary MDI), and ensure emergency plan is in place before continuing pump use.
Clinical Guardrails / Mimics / Pitfalls
Do not assume competence based solely on device ownership; avoid overlooking cognitive or visual impairments that hinder alarm recognition; do not ignore repeated alarm fatigue as a sign of misunderstanding; never let the patient continue using the pump without verified troubleshooting ability due to risk of DKA or severe hypoglycemia.
Concrete Clinical Example
A 58‑year‑old with T1D reports frequent “no delivery” alarms; on review she cannot locate the reservoir or restart priming and relies on her spouse to fix occlusion. Assessment shows assisted troubleshooting → arrange hands‑on pump training with a diabetes educator and simplify to semi‑automatic mode.
Source: Endocrine Society Clinical Practice Guideline: Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults, 2016, Table 1. CSII—Considerations for Education and Training, doi:10.1210/jc.2016-2534