Ok, imagine this...
You use an insulin pump. You are usually very good about redoing your site every 2-3 days and making sure your pump never goes empty- BUT for some reason today you forgot to check your pump, or you ate a really huge meal for lunch or you sprang a leak. You are sitting at work and your pump alarms, you are completely OUT of insulin!
Do you sit there and wait for the day to end? Or do you hoof it on home as fast as you can?
What if the day is over in an hour?
What if the day is over in four hours?
What if the day just started?
Imagine your home is not easy to get to- 45 minutes for a one way trip, and you'd have to change your pump in between as well, so figure 2 hours for the whole trip. You'd definitely miss work and would have to report to your managers if you chose to leave early.
So, what do you do?
That happened to me once. I was out to lunch and I went to bolus and realized I only had one unit left!I had heard my "10 units left alarm" but then forgotten it. So I ate very little carbs and went home right after lunch. If I were working full time and lived 45 minutes from home, I would make sure I had supplies at work or in the car so I could change sets in case of a crisis. If I hadn't done that? An hour I'd just wait. Four hours it would really depend on my work situation and how much of a negative it would be to leave that much early. The whole day? I'd leave.
I don't let my pump get that low. Maybe it's wasteful, but I will change out even if there is 20 units left, just because I don't want to have to fight traffic to go clear across town...30 minutes each way IF your lucky, then mess with the pump. I suppose for me..it would all depend on what time of the day it was. It there was only an hour or two left to the day, I'd probably just say to heck with it, and wait till I get home. If the day was just starting, then I'd end up just taking some personal time to take care of it.
I have MM pump, and I know that when it says 0 units left, it's not true ! I have confirmed this when I have changed out my sets, by detaching, and just running a large bolus (or Prime so it won't be IOB) to see just how much is really there.
Usually I find 5-10 units past the point where it thinks 0.
I haven't yet had to rely on that, but it's good to know there's a little wiggle room.
If I knew it was really empty (ie NO Delivery Alarm), then I would make sure I can refill within 1-2 hours. If I don't have insulin, or not able to get home, I would get to a store like Walmarts/CVS and buy Regular insulin. I always have syringes for emergencies like that, or they can usually be purchased OTC.
But you should always be prepared with a backup plan. Do you keep extra infusion sets at work / with you at all times ? What if you accidentally pull one out, or a cat nibbles on the tubing (Yes, my friend's cat did that) ! Or for those with Omnipod that knock it off by accident.
If you have a job where you can not leave, then I'd recommend that you always carry full backup supplies, including insulin.
Personally, I would never go more than 2-3 hours w/o insulin, even if it meant I had to leave my job for a couple hours. It's a medical emergency, no different than if you cut your hand and had to leave to get stitches.
I always have extras of everything on me. If I didn't, my boyfriend would die from fear of me dropping dead at work/at the gym/on the street... I figured his piece of mind was worth being prepared :P
I've gone home occasionally, like twice. I'm about 15 minutes away and usually just do it as a lunch errand on those occasions I've forgotten to swap out a set. I have a set in my glove compartent, after having some pull-outs a couple of times during long runs in 2011 but I've never used it. Another thing I've done, since I like to run the reservoirs down to the bottom of the barrel, is to take a "reload" and swap it out at my cube. I've also had a couple of times where it was close and I've cut the basal to like 85% and sort of kept an eye on it w/ the CGM and done ok.
This has happened to me ... er ... regularly. :) I carry spare pump supplies for this reason (now, didn't used to), but before I did that I used to just go back to shots for the day. Annoying, but better than missing work.
I am trying not to let it happen as much because my endocrinologist was not happy about it at our last appointment!
I carry extras with me at all times as well, Jen :) I learned early on with the pump that Murphy's Law is always in effect! I carry extra pods and insulin and a syringe. My humalog peaks in 2 hours and is done in 4. No way could I wait more than 1 hour without my blood sugar rising.
When I was working, I kept a full blown emergency (think evacuation) kit in my office. In it I had two weeks of supplies--pump and meds and all the stuff that goes with it like batteries, exttra charger for the CGM--you get the idea. I also taped a complete list of my medications, dosages, etc. and kept a bottle of insulin in the frig. I also made sure my coworkers know what it was.
I know this is paranoid but there were two really good reasons:
1. I live in the Washington D.C. suburbs and evacuation is always possible. My husband worked in D.C. and I was in the outer suburbs, so we would evacuate seperately.
2. If I was hauled out of work in an ambulance, my coworkers were to make sure the emergency kit with the insulin went with me.
Therefore, if something occurred at work, I was always prepared. If I am out and something happened, I just go home.
In this hypothetical, it would depend on many variables. What am I doing that day, what are the deliverables/timelines, etc. What was my BG before lunch, have I been running high/low recently, etc.
I would most definitely discuss with my manager (that's part of a manager's job, isn't it?). Afterwards, I would follow-up with my manager to discuss how this was an unusual occurrence and the steps I am taking to ensure it won't happen again in the future.
There is definitely more insulin in the reservoir, the only problem is you don't have an accurate way of measuring it. If in a pinch, though, I would use it - maybe to correct a high.
If I was completely out of insulin I dont think I have much choice but to go home and take care of myself. I would assume at 1 hour I will start feeling bad from the hyper. At 2 hours I will be feeling quite bad and possibly spilling ketones. At 4 hours there will be almost no insulin in my system. I will be spilling ketones, in bad shape and the situation is becoming dire.
I carry my Humalog with me in my PDM case for my OmniPod and I always have a couple of extra pods in my "work bag" (big leather tote), along with a couple of syringes, an extra Dexcom sensor, and my cord to charge the Dex receiver. I try to be prepared because I'm a worrier by nature and being prepared gives me peace of mind.
If any of the scenarios above happened, though, I would treat it as a medical emergency and take leave time to go home and address it. It's no different to me than if you got sick at work. Of course, part of my mindset is probably because my work environment allows for that. If it didn't, all the more reason to be prepared so you don't have to leave. :)