for several days (with tubing attached to the person’s body), removed, and replaced, thus saving on the initial financial investment. There are many different pump brands and models to choose from.
Most pumps connect to the body via tubing of various lengths and an infusion set. A patch/pod or “tubeless” pump system consists of an integrated glucose meter and remote control device to operate the insulin “pod,” which is attached to the skin similarly to an insulin infusion set with self-adhesive tape. An insulin pod is a combination of an insulin pump cartridge/reservoir and infusion set. The patient fills the pod with the amount of insulin to be infused over several days and attaches the pod via the built-in cannula. A patch/pod pump eliminates the need for tubing, as the infusion set and pod holding the insulin are an integrated system. The pod delivers the insulin using the remote control device that is programmed with the user’s pump settings, such as basal rates, bolus options, etc. Some models provide the option of delivering a bolus directly from the pod.
After 2–3 days’ use, the pod is disconnected from the skin and discarded, and replaced with a new pod that the pumper again fills with the appropriate amount of insulin. A pod is shaped similarly to a small half hard-cooked egg and is attached to the body with self-adhesive tape. Once in place, it is not “moveable,” as there is no tubing. Patch or “pod”-style pumps provide another option in pump therapy without the “hassle” factor of tubing. Many people prefer the freedom that a tubeless pump allows, while other people may not like the “immovable lump” appearance of the patch pump and might prefer to “move the pump around” and wear it outside or inside clothing. Of course, pod placement can be as discreet as wearing a tubing-style pump under the clothing.
Insulin Pump Options and Selection
Experience with one brand of pump may bias a physician or educator toward that pump even when another brand or model may suit the patient as well, or better. Sometimes clinicians assume that their personal preferences for pump features are the same as the patient’s. As much as possible, allow the patient to choose their pump. Remember that you are preparing and managing the patient’s pump therapy, NOT training the patient on the “buttonology” or button-pushing aspects of the pump. Don’t allow your personal pump brand choice, bias, or comfort level with a particular brand dictate the pump the patient chooses. The patient’s preference is paramount and can be a factor in successful implementation of pump therapy.
Deciding on a suitable choice usually takes time. Give the patient enough time to read the marketing literature, surf the various pumps’ websites (some have “virtual” interactive pumps to simulate use/practice), view the various pump manufacturer DVDs, review diabetes publications comparison lists and articles about pumps, and meet with the pump manufacturer sales representatives and/or clinical staff. As the prescribing clinician, if you have been provided with several manufacturers’ “demo pumps,” offer to demonstrate several pumps to the patient. This may be helpful after the patient has done some research and is able to discuss features that appeal to them. Remember that, like all cars that get you from one place to another, all pumps deliver insulin but vary in their colors, options, features, and degree of sophistication.
Pump Criteria Checklist
General
Is the pump a patch/pod type, eliminating the need to be “connected” to infusion set tubing 24/7 but requiring a remote device or wireless device/meter combination for all programming?
Does the pump have advanced programming features that would be used for “fine-tuning” 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
