The International Society for Pediatric and Adolescent Diabetes (ISPAD) recommends using automated insulin delivery (AID) systems as the standard of care. These systems have consistently been shown to help people with diabetes achieve their glucose goals. However, no system is perfect, and each has its own challenges. Here are some common issues that arise with diabetes technologies.
The weakest link: the infusion set
Getting insulin into the body adequately is still the crux of any AID system or insulin pump. Many things can go wrong, from scar tissue to adhesive issues, kinked cannulas to unidentifiable absorption issues. In the DERMIS study, researchers examined the skin from current and past infusion sets. They found that many people showed changes in the skin related to inflammation, death of fatty tissue, and scarring of the connective tissue. Additionally, different chemicals found in the skin around infusion sets suggest an allergy may have developed.
There have been countless times in my 26 years of using an insulin pump when my blood sugars were high without an obvious explanation. We were always taught: “When in doubt, change it out,” so that is what I have done. It was previously believed that the typical reason an infusion set wasn’t working was due to scar tissue – something that would be blamed on people’s inability to rotate infusion sets adequately. But this recent data shows that it could literally be our bodies having an allergic response to the conduit getting our life-sustaining medication into our bodies—yet another reason to challenge the concept of adherence.
Battery life
All AID systems run on some type of battery. Some are rechargeable, whereas others require a battery change. There has to be enough battery power to run the device and its algorithm in order for the system to keep working. This sounds simple enough, but I’d like you to consider your cell phone. Have you ever let its battery die? Have you looked down at your phone and realized you only had a small charge left?
Maybe you were at work and thought, it’s fine, I’ll be home in a few hours. But what if the battery is your “pancreas,” and you can’t get home for several hours? Hopefully, you have a backup plan, but sometimes you don’t because YOU ARE A HUMAN BEING, and you make mistakes. The best you can do is try to get into a routine for charging your device and have backup plans in place.
Here are my top tips for keeping your AID battery system charged:
- When you disconnect to shower or bathe, plug in your device to charge
- Before leaving the house for the day, check the charge level
- Before going to sleep, check the charge level
- Keep a charger in your car, at your work/school, or in your diabetes bag
- If your device uses a battery that needs replacing versus charging, keep a backup in your diabetes bag
- Have a backup plan for if you cannot charge, and make sure it is with you – it doesn’t do you any good at home if you’re not there…
Running out of insulin
Insulin is liquid gold. It is one of the world’s top 10 most expensive liquids and my literal life source. It’s easy to understand why many of us wait until the cartridge is almost empty to change it. But you can’t forget to bring insulin and supplies to change your pod or cartridge when you leave the house. I have done this a number of times, thought that I had packed the supplies I needed before leaving for work, and subsequently had to leave work early. I’ve also avoided eating any carbohydrates while at work to help extend the life of my cartridge. None of it is fun, but sometimes you gotta do what you gotta do.
Tips for avoiding an empty cartridge or pod:
- Before leaving the house for the day, check the remaining insulin in your device
- Before going to sleep, check the remaining insulin in your device
- If you find yourself running out of insulin often, set the alert on your device for a higher threshold (For example, 30 units instead of 20 units)
System malfunctions
None of these systems is immune from the usual technology woes, and issues can occur with the device’s hardware. Sometimes, the battery will not charge, and the device needs to be replaced. When errors or issues like this occur, you’ll need to call the device company to determine what to do. This is yet another reason to ensure you have an adequate backup plan for going manual mode.
Sharing your glucose data
If you are the only person with access to your glucose data, I implore you to find someone to follow it. I realize that sharing your data is a very personal thing, but there are so many circumstances in which having someone else to be your backup is critical. Whether we want to talk about it or not, people still die from diabetes. Personally, it’s not what I like to think about, but it is a sobering fact that I don’t want anyone to forget. In this study, published in May of 2024, sleeping was one of the top three reasons people with type 1 diabetes using an AID system died. We all sleep, ideally every night, and many of us sleep through our alarms.
Ensuring someone else has access to your data could save your life. I have received many phone calls in the middle of my sleep from people who had been alerted to a low glucose of less than 55 mg/dL (3.1 mmol/L). This means my devices had been alerting, and I had slept through the attempts to wake me. When you get alerts often, becoming immune to the noise can be easy, especially if you’re extra tired, have had an alcoholic beverage, or are jet-lagged. I have recently discovered that international travel can be very beneficial to have multiple followers in varied time zones. This way, someone is usually awake while I’m sleeping, and they are my backup.
No one wants to experience any of this series of unfortunate pump events that can occur, but the reality is that we all will likely have some of these issues from time to time. For me, I’d rather do the work required to use the AID system to get the outcomes I want than the work required in manual mode. There are risks either way, so you have to choose which battles you are willing to fight.
Written and clinically reviewed by Marissa Town, RN, BSN, CDCES
