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My perfect pump

Richard Oppenheimer looks at what he wants from a perfect pump

Can you remember the days when computers were about as user friendly as a tank full of piranhas, or when mobile phones needed you to spend a week reading the manual before you could even make a call? Well sometimes looking at today's insulin pumps it all comes flooding back.

Let's face it - insulin pumps aren't cheap. So having spent a day drawing out a flowchart just to try and work out all the commands on a MiniMed 507, and realising that most of the other pumps were no better, I decided to write down what I expect to see in a well designed pump - and why I hate some of the ones on offer now.

Seriously though, your insulin pump is the most intimate purchase you're likely to make. It's your little friend that keeps you alive. It's going to live with you 24 hours a day for the rest of your life. And there's a few pumps around I wouldn't want to go to bed with!

Meanwhile, here's what I think is the very least you should expect from a decent pump. When I find one that measures up I'll let you know.

If you're a pump user I'd love to hear from you what you hate - or love - about your pump. If you're a pump manufacturer - I'm waiting for your call!

Safety

Let's face it: your life depends on your pump. So this has got to be the number one priority.

Are operations which are potentially dangerous (like priming, or cartridge change) arranged so you can't perform them by accident while your pump is running and attached to you?
Will the pump fail catastrophically if one of the batteries goes down?
Can the buttons be pushed accidentally while the pump is in your pocket?
Will it malfunction if you accidentally put it in the same pocket as your mobile phone?

User interface

Probably sooner rather than later you're going to have to use your pump in the middle of a hypo and there's nobody else to do it for you. So:

Are the commands logical, can you use it without thinking?
Do all the commands have a common look and feel?
It is designed so you can't get into a dangerous situation by accident?
Does it have on-screen instructions in plain language which are clear enough to read in poor light, or if you - like a lot of people with diabetes - are sight impaired?

Functionality

This is the absolute minimum you need:

simple one-shot bolus,
extended duration bolus,
ability to give a one-shot bolus while an extended bolus is running,
'any-key' panic interrupt of bolus delivery,
24 hour programmable basal rates with several different selectable profiles (particularly for women),
temporary basal rates with programmable timeout,
easy user interrupt of extended duration bolus or temporary basal rate,
a memory giving you your last few boluses, total insulin used today, summary of insulin used the last few days, a counter showing the amount of insulin left in your cartridge,
alarms and status information displayed in plain language.

Ease of use

Are the buttons well laid out, can you feel them easily, or are critical buttons easily confused in the dark or if you are holding the pump upside down?
Are the on screen commands clear, unambiguous and in plain language?
Is the command structure logical and easy to use?
Can you operate it through your clothing and be confident you haven't made a mistake?
If you're not too technically minded do you feel confident with it?
Is it easy to change or refill the insulin reservoir?
Could you operate it while you are having a hypo?

Accessibility

Could it be used by someone partially sighted?
Does it have on-screen instructions which are clear enough to read in poor light, or if you are sight impaired?
What if you have neuropathy, and poor feeling in your fingers?
Are the audible signals meaningful?
If your sight is bad, are the audible signals good enough to tell you what's going on?

Support

How good is the manufacturer's backup?
How fast can they get you a spare pump, or do they provide you a backup?
And if you are in difficulties can they talk you through it?
Does it use readily available batteries or are you going to be stuck when your spare turns out to be a dud?
Is the instruction manual downloadable from the manufacturer's website (remember, you're unconscious in hospital and someone needs to know how your pump works)?
And is the website marked on the pump?

Styling and comfort

We never thought of a pump as a fashion accessory - but when you wear it everywhere you go, you want it to look good. Especially if you are style conscious.
And when you roll over on it in bed you don't want it to dig into you and wake you up.
There's no such thing as a pump that's too small, but you don't want it to be fiddly.
Whether you prefer pre-filled cartridges or a refillable reservoir is a matter of personal choice, but bear in mind that a pump which takes pre-filled is likely to be physically larger, and re-filling isn't usually too difficult once you've got the hang of it.

Technology

Does it use up-to-date technology or is it starting to look a bit dated?
Can the manufacturer easily update your pump's software to give you the latest functionality?
Is it reliable?
Can you download data from your pump to your PC, and then integrate that data with data from your glucose meter?
Is it ready for interfacing with the next generation of continuous glucose monitors?

Out of the box

Can it be used by someone who hasn't been explicitly trained to use your pump?
What happens if you find yourself in the hands of medics who need to operate your pump for you?

Engineering

Designed so that bubbles get trapped and aren't easily passed into the infusion set.
Designed so the pump gives doses of insulin at regular frequent intervals, especially important if you have low basal rates.
Sufficiently robust for your lifestyle.

See our other page where members of the Insulin Pumpers UK discussion group say what they don't like about their own pump.

Add your comment

Author: Richard Oppenheimer <r.oppenheimer@btinternet.com>. Richard Oppenheimer is not a medical professional. He has Type 1 diabetes and uses an insulin pump. The information given here is based on his own personal experience. More about Richard Oppenheimer...

Created: April 2001; Last updated: Monday 8 May 2006

Reader comments

On 9 Nov 2005 Joan Kraus wrote:

My pump warns me when the reservoir is getting low, but when it is actually empty, you could put in a bolus and it reads as if there was insulin there. It should say it's empty and give a warning.
On 6 Jun 2005 Vivienne Garbacki wrote:

After just reading "My Perfect Pump" it makes me think back over the last 53 years. I was born with diabetes in 1952 & back then it was difficult to keep any kind of good control over diabetes... Until the start of "Penjectors" which helped a little, THEN 10 years ago I was given an insulin pump by my local hospital diabetes team... It is a Mimimed 507. I have used it constantly over the last ten years: it has been the best thing I have ever had regarding my diabetes. It isn't very big, I wear it on my waistband or clipped to my bra. Since starting pump therapy I have more or less been able to forget I have diabetes. It is the most wonderful invention I have ever come across... I really don't understand people who complain about the pump maybe being seen by other people, as we're talkiing about LIFE here & AVOIDING complications... I have not had any problems at all with my pump. I find it easy to use. I have never pressed any buttons by mistake. It has alarms for many things: the main ones I watch out for are low battery warnings & no delivery warnings which usually means I have forgotten to fill the pump's reservoir (which is my fault not the pumps)... I would suggest anyone who is not sure about using a pump finds somewhere they may be able to have one on loan to try it (usually a hospital diabetes team). I think they might just be pleasantly surprised at the freedom & good control the pump offers... Thank you. Viv Garbacki
On 19 Oct 2004 Michael wrote:

I have been living with diabetes sence I was ninteen years old and doing very well with it compaired to people I know who also have diabetes. About three years ago my doctor suggested that I may want to use the pump for better control. Everything started out fine at first until, all at once I started to have problems with low blood sugars for no reason. Then I had problems with the batteries going dead after a few weeks. They sent a new pump and this one had more problems with low blood sugars and the batteries were dieing in just days. I had two low blood sugars that could not be read on the meter. After that I took the pump off and went back to the syringe. I started to have magor problems with thinking, talking and just day to day things. My doctors say that I have damaged cells in my brain from such low blood sugars. Not a good time for me.
On 17 Jul 2003 Leigh wrote:

My best friend wears a pump and also carries a blood glucose monitor. Why doesn't someone come up with a blood glucose sensor that is built into the pump and also "attached" to the patient to constantly monitor sugar levels? With this type of bio-feedback to the pump, insulin dosages could be automatically adjusted by the pump and be held within a normal range. In my opinion, that would be the perfect pump. Isn't that how a pancreas works? I hope researchers and engineers are working on this.
On 3 May 2003 Patrick Mulcahy wrote:

Like many adults who began as juvenile diabetics, I was ostracized by my school-mates. Consider the plight of the child today with aids.

Whenever I've asked manufactures' reps, e.g., Medtronic, why they can't design a pump that can be hidden in plain sight - their eyes glaze over - why don't they understand my desire to hide it?

American culture is harsh. For example, senior executives responsible for large revenue-streams are soon pushed aside when they've had a heart-attack, stoke, cancer, or diabetes. Twenty somethings shouldn't have to explain their health problems on a first date, etc.

Yet the manufactures seem to thing I wish to be their bill-board!
On 6 Jun 2001 Leslie wrote:

Very interested in the perfect pump idea, but as a potential pumper who finds that a great deal of good luck is just out of my reach, your safety section SCARED me. I'm sure I'll just happen to get the world's most malfunctioning pump, with an insulin reaction that will put me in the Guinness world record book. And really - tell the truth now - do pumps give the flexibility et al that the pump companies claim - HARD TO BELIEVE FROM WHERE I SIT, needle in hand.
On 1 Jun 2001 Jorge Mendoza Lopez wrote:

I'd like to be able to swim with my pump on. Also, I'd like it to be as small as possible. And I would definitely like the downloading software to be available to pump users... or do you think we are stupid?? A conscious pump user can spot much more things than many physicians around UK.