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Patient Profiling

Alternative Insulin Delivery Self-Assessment Tool

As our customer, we value your business and would like to know how we can better assist you with managing your diabetes. We have created a self-assessment screening tool to help you identify criteria for other insulin delivery methods.

Tell us about yourself

How do you manage your diabetes?

**If on pump, STOP - go to Tell Us About Your Diabetes

Long acting:
Short acting:
Humalog units:
Novolog units:
Apridra units:
Mix 70/30:
Mix 75/25:
Last two HbA1c lab results:

Tell us about your diabetes:

Highest and lowest blood glucose levels within the last month:

If you answered “Yes” to more than 3 of the above questions, you may be a candidate for an insulin pump. Conact DMS at 1-888-738-7929 to discuss your options, or submit your name, email, and phone number below to have one of our representatives contact you.