 To achieve optimal use of the insulin pump, patients must engage in frequent Blood Glucose Monitoring BGM and insulin bolusing, and have an understanding of their relationship. BGM must occur and then it must be followed by a decision about what to do or not do regarding insulin bolusing. If insulin bolusing occurs in the absence of BGM, hypoglycemia and less than ideal glycemic control can occur. Of the few insulin pump adherence studies, only very basic adherence behaviors such as BGM and insulin bolusing frequency or number of hypoglycemic events have been reported. 