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. 2018 Apr 18;14(1):47–51. doi: 10.17925/EE.2018.14.1.47

Table 2: Questionnaire for assessing safety of insulin delivery device.

Safety assessment questions
S No Question Options Score*
1 How painful is the process of injecting your insulin? Acceptable pain
Bearable pain
Unbearable pain
1
2
3
2 How many bruising episodes at injection sites have you had in the last 5 days? None
1 episode
>1 episode
1
2
3
3 How many episodes of high sugars (your perception) have you noticed in the last one week? None
1 episode
>1 episode
1
2
3
4 How many episodes of low sugars (your perception) have you noticed in the last one week? None
1 episode
>1 episode
1
2
3
5 How many times have your broken your insulin vial/cartridge in the past one year? None
1 episode
>1 episode
1
2
3

*Scoring as per response. Minimum score of 5, maximum score of 15. Lower score indicates safer device and a higher score denotes a more unsafe device.