Putting Your Patients on the Pump. Karen M. Bolderman

basal and bolus delivery and be implemented over time? Some pumps are sophisticated or “smart” and have options for fine-tuning insulin, while other pumps offer basic basal–bolus features that may be more appropriate for a person with type 2 diabetes who would not use the sophisticated, more advanced “smart pump” features.

      • Ease of navigating on-screen selections (user “friendliness” or intuitive use) Does the pump utilize touch-screen technology and/or have minimal button pressing and scrolling?

      • Is the pump screen easily visible? Does it have color and/or contrast making it easy to see and operate under a variety of light conditions?

      • Use of icons, words, or abbreviations (and color)

      • How much memorization is required? Is it difficult to remember how to move from one screen or function to another?

      • For a child, could someone only slightly familiar with the pump (caregiver, teacher, babysitter) stop it or perform troubleshooting? Is there a lock feature and/or remote control?

      • Ease of manual tasks: Could a user with hand arthritis, carpal tunnel syndrome, or neuropathy use the pump easily?

      • Does the user need to fill the cartridge/reservoir with insulin or does the pump use brand-specific pre-filled cartridges? Are there many steps in “loading” the cartridge/reservoir into the pump?

      • How many steps are involved in changing or entering a program?

      • Can the pump user choose between hearing audible sounds and alarms (in varying sound volumes) and a vibratory mode for all pump functions?

      • How long does the battery(ies) last? Are batteries easy to obtain and replace? Does the pump require charging and how often? How easy is it to replace a lost charger or obtain a back-up charger?

      • Does the pump have a specific infusion site/set change reminder alert or alarm that can be programmed to sound or vibrate at a time chosen by the user every 2–3 days (or as determined appropriate) to serve as the reminder to change the infusion set/site? This is one of the most useful features ever designed for insulin pumps. A “general” or non-specific alarm that can be set for whatever reason the pump user decides is not nearly as useful. The importance of changing the infusion site/set often cannot be stressed enough to new as well as experienced pumpers.

      • What type of clock is available, 12-h or 24-h? Does the pump have the option for both 12-h and 24-h? This is important, as patients who use the 12-h clock may inadvertently switch AM to PM and deliver the wrong basal doses throughout the day. Downloaded history may not alert the patient to this error. Most pumps today offer both clock options, but basal rates are most accurately programmed using the 24-h clock.

      • Does the pump have multi-language capacity?

      • What is involved in detaching the pump?

      • Does the pump have a backlight? How long does the backlight stay lit, and is the duration of time adjustable?

      • Is the pump waterproof or watertight? Does it require any special accessories to make it waterproof? This is a consideration not just for water sports, as daily activities also expose the pump to water, such as accidentally dropping the pump into the toilet or using it in the shower/bath.

      • What is the size of the pump? How thin is the pump? Can it be worn discreetly under clothing?

      • How much does the pump weigh?

      • Does the pump have the option of using a remote device for all its programming and delivery functions?

      • Is there an audio, vibrate, or remote option for patients who want to wear the pump discreetly?

      • How is a patch/pod/tubeless pump attached to the person? How strong is the adhesive? Can the pod be temporarily disconnected?

      • How is a standard pump with tubing worn/attached to the person? Are there options, including a removable clip, a case with a built-in clip, a case with built-in belt loops, or a choice of other cases? Is the case available in a variety of colors and materials (leather, vinyl, plastic, etc.)? Do case options include something like a “skin” used on cell phones to provide a grip and ease in holding the pump? Will the pump fit into a “universal” case, i.e., one that accommodates various pumps so that the patient may be able to purchase a case from another pump manufacturer?

      • Is the pump available in more than one color? If not, can the user change the outside color or appearance of the pump?

      • With what device can the pump communicate? Most insulin pumps can wirelessly communicate with either a blood glucose (BG) meter or a continuous glucose monitor (CGM). As of this writing, interconnectivity among all three devices is not yet available, but the integration of these technologies is on the horizon. Determine what is most important for the patient—the ease of wireless transmission of the BG from the meter to the pump for calculation of insulin doses, or use of a CGM device.

      • What types of history does the pump store? Percentage of total daily dose (TDD) as basal and as bolus? Most recent boluses? A summary of daily delivery, including TDD, an average of TDD over X number of days, amounts of insulin delivered as correction boluses and meal boluses, infusion set changes? Total history, including alarms, alerts, battery changes, infusion set changes, and basal rate/pattern changes?

      • Does the pump include software to download data reports of various types that can be used by both the patient and healthcare professional to track trends, make changes and corrections, and monitor overall use of the pump?

       Insulin and insulin delivery

      • What size is the cartridge/reservoir, i.e., how much insulin can it hold? Does the pump use a disposable cartridge/reservoir, or is the cartridge “built into” the pump? How much insulin can the cartridge/reservoir hold? This varies, and as of this writing ranges from 176 units to 315 units. This is important for people who are insulin resistant or use large doses of insulin. Remember that tubing connects the cartridge/reservoir to the infusion set and the tubing must be primed (filled) with insulin with each infusion set change (see Sets with tubing). A set change occurs every 24–72 hours, and the amount of insulin (approximately 20 to 45 units depending on the tubing length) changed/wasted (from discarding the tubing) should be taken into consideration. This may increase overall costs of the insulin supply. Overall, this is an important consideration in choosing a pump whose cartridge/reservoir contains <200 units for use in a patient requiring >55–60 units/day.

      • Some pumps make noise during basal and bolus deliveries. The noise can be a “clicking” or “zzzz-sounding” type noise. Does this matter to the user?

      • Frequent insulin delivery is an important issue for infants, toddlers, children, and insulin-sensitive adults. If the infusion set cannula or metal/steel needle is not infusing insulin constantly, subcutaneous or scar tissue may build up and occlude the site, impeding basal delivery. In contrast to pumps with solenoid motors, a direct-current motor pump delivers fractions of any basal rate, no matter how high or low, in “micro” pulses every 3 minutes. Insulin-sensitive patients are better matched to direct-current motor pumps.

       Basal rate delivery

      • Does the basal rate deliver in increments of 0.10 (tenth of a unit), 0.05 (twentieth of a unit), or 0.025 (fortieth of a unit)? Smaller increments are useful for fine-tuning basal rate delivery in children and insulin-sensitive people.

      • Can the user temporarily increase and decrease basal rate delivery, and for how long? Can the pump be programmed to automatically calculate increases or decreases in percentages for several different basal rates, or can it alternately just calculate the number of units or units/hour? A temporary basal increase is helpful for acute illness or preceding menstruation, whereas a temporary decrease in basal delivery is useful for exercise.

      • How many 24-h basal rate programs can be programmed into the pump? This is useful for patients who want to accommodate activity levels that vary day-to-day. For example, if weekend activity levels are different from weekday