A patient on an insulin pump experiences a kinked tubing or pump disconnect. What is the priority action?

• A. Reboot the pump and resume previous settings without checking glucose.
• B. Administer rapid-acting insulin manually from syringe, ignore pump.
• C. Check blood glucose, reconnect or replace pump, and provide rapid-acting carbohydrate if needed.
• D. Tell patient to wait until the next scheduled bolus.

Answer: (C)

When an insulin pump has a kink or disconnect, the immediate danger is interruption of insulin delivery, which can lead to hyperglycemia and possibly ketosis. The priority is to determine the patient’s current glucose level to guide the next steps and to restore insulin delivery as quickly as possible. Start by checking blood glucose with a finger-stick. Then reconnect or replace the pump to resume insulin delivery, because restoring ongoing insulin is essential to prevent rising glucose and metabolic complications. After insulin delivery is reestablished, assess the glucose reading and patient’s symptoms; if hypoglycemia is present, provide a rapid-acting carbohydrate to raise the glucose to a safe level. If glucose is normal or high after reconnecting, you would not give extra carbohydrates.

This approach avoids delays in insulin delivery, which could worsen hyperglycemia, and it avoids giving insulin without confirming glucose status, which could cause hypoglycemia. Waiting or ignoring the pump issue is unsafe, and simply rebooting or giving insulin manually without glucose assessment can lead to further complications.