Is an Insulin Pump right for me?

What are the criteria used to decide if Insulin Pump Therapy is suitable for me?

The criteria used in Wales and across the United Kingdom , to determine suitability to use an insulin pump are written by the National Institute for Health and Care Excellence (NICE) .

NICE criteria (Technology Appraisal 151 (2008)) for NHS funding are* :
  • Your diabetes consultant recommends that you use an insulin pump.
  • You're having frequent hypos or hypos without warning that cause anxiety and have a negative impact on your quality of life
  • Your HbA1c is still 69mmol/mol (8.5%) or above, despite carefully trying to manage your diabetes

You can read the full NICE TA151 Guideline HERE –hyper link


What else will I have to do to demonstrate my readiness for Insulin Pump therapy?

In addition to the above criteria you will need to demonstrate that you are committed to improving your diabetes. The box below provides a list of the requirements that your diabetes centre may ask you to demonstrate before considering pump therapy as an option. This is not a definitive list, if you meet the criteria above then your local team can advise on your specific needs and eligibility. 

  • Taking at least 4 injections per day
  • Checking Blood Glucoses / Finger Prick Tests at least 4 times a day
  • Have the ability to adjust insulin doses and accurately count carbohydrates
  • Attend relevant education in preparation for staring on insulin pump therapy which may include upskilling your diabetes knowledge.
  • Attend clinic regularly/avoid not attending – keeping in contact with your team is vital when starting/using an insulin pump.

What are the advantages of Insulin Pump therapy?

Below is a list (not exhaustive by any means!) of some of the benefits of being on an insulin pump. 

 

Improved Diabetes control First and foremost. Pump users tend to have improved control and less glucose variability (fewer “high to low” and “low to high” swings) than those on injections.
Reduced Hypoglycameia

By using only rapid-acting insulin, there is no long-acting insulin peaking or working too hard at inappropriate times. This makes pump therapy a good choice for those who have frequent lows, a history of severe lows, or a hard time detecting low blood sugars.
A more flexible lifestyle


Being on an insulin pump can lets you choose your own schedule so exercise, eating and lifestyle are on your terms!
Dose calculations   Most insulin pumps come equipped with a bolus calculator that helps the user determine mealtime doses based on carb intake, blood glucose levels, and the amount of insulin still active from previous boluses.
Precise dosing

Insulin pumps deliver insulin to the nearest .1, .05 or .025 units; ideal for those who are sensitive to very small doses, such as children and lean/active adults.
Convenience

There is no need to draw up syringes or get your Insulin Pens out every time you need insulin; just reach to your pump and press a few buttons.
Reduced number of injections  Multiple daily insulin injections can be uncomfortable and cause skin problems; pumps only require a needle stick once every 2-3 days to change the infusion set. Its worth noting that occasionally you mau still require insulin injections to correct very high blood glucoses and or in the event of a pump failure.
Easy adjustments for real life  Temporary basal insulin changes help maintain stable blood sugar during periods of growth, illness, seasonal sports, dining out, and menstruation. The ability to deliver boluses all at once or over a prolonged period of time can be instrumental in achieving optimal after-meal glucose control.
Weight control Eat what/when you choose; snacks are not required when you use a pump.

Data analysis

 

Insulin pumps store a plethora of historical information that can be displayed on-screen or transmitted to various computer programs for analysis and fine-tuning.

What are the disadvantages of Insulin Pump therapy?

As you might imagine the purpose of insulin Pumps Wales is to promote the use of Insulin Pumps in Type 1 diabetes. It is however it is important to acknowledge the potential drawbacks and frustrations you may experience on an insulin pump it is worth noting that these issues/ occur more so in the early days and less and less frequently as your experience with insulin pumps develops.

A steep learning curve  Don’t expect good control right away. It usually takes a few months to get the basal and bolus doses regulated and to adjust to using the pump correctly. Some people report feeling like they’ve had to relearn their diabetes when transitioning to an insulin pump – these are generally people who have had diabetes for a long time)
Inconvenience  Wearing the pump around the clock, even during sleep, can become awkward once in a while. Sometimes the pump can get in the way of contact and or other sport activities or the lines can get caught on the door handle!
Technical Difficulties  As mechanical devices, pumps are prone to occasional infusion set clogs, electronic failures, computer glitches and damage due to typical wear and tear. Insulin Pumps tend not to do well after being dropped from height!
Skin Problems Skin can become irritated from infusion set adhesive, and infections can occur if infusion sets are worn too long or inserted improperly. Insulin absorption can be hindered if infusion sets are not changed regularly and sites are not rotated properly
Increased Risk of Ketoacidosis (DKA)  The absence of long-acting insulin with pump use can present a problem if insulin delivery is interrupted for more than a few hours. Blood glucose can rise very quickly, and ketones may appear in the bloodstream if the problem is not corrected. Diabetes Ketoacidosis is a serious condition which requires urgent action / medical attention. 
Infusion Set Changes  Every couple of days, the pump user must change his/her own infusion set. This three-minute to 10-minute procedure involves numerous steps and can be momentarily uncomfortable or traumatic for the beginner / novice insulin pump user.
Carrying Supplies as a backup  Sometimes it can feel like you have to be a walking pharmacy-there are a number of things that an insulin pump user needs to carry around with them at all times this includes spare cannula (in the event of displacement or requiring a change), spare infusion sets, batteries, back up insulins, testing kit, spare strips to name but a few. A suggested “Kit list” is available for download from our Resources Page.

If I am assessed as “suitable” for an insulin pump can I pick the model I want?

There has recently been a new document produced by the National Wales Shared Service Partnership (or NWSSP) who are responsible for the purchase of all NHS equipment including Insulin Pumps. A great deal of work went on “behind the scenes” and as a result we now have a choice of five insulin pump systems that can be used in Wales (see below) from Medtronic, Roche, Animas, Cellnovo and Ypsomed/My Life. You can find out more about each model currently available in our “ Devices” Section.

In some centres you may be able to have the insulin pump that you want after a discussion with your team. However, it is really important to note that some centres currently may only offer one or two types/brands of pump at the moment. The way insulin pumps work are all the same in that they deliver insulin through a cannula but some of the technology involved, terminology and processes vary a great deal between different devices which means centres have chosen to be expert in one or two specific devices whilst they learn and become familiar with other models - your safety on an insulin pump remains the most important factor at all times. This may mean your choice of device in relation to the list of available might feel somewhat limited.

Whilst we understand this might seem frustrating the Insulin Pumps Wales Network and all centres in Wales are working together and towards upskilling all teams to offer a wider choice of devices and this may take some time to achieve. Also, there are new technologies/davices coming through all the time and often it is difficult to keep up with the pace. Rest assured, we are constantly in contact with the Insulin Pump Companies and when we have news to share on new models/devices and when they might be available you’ll be able to hear about them on our News Page!


Is Insulin Pump therapy for everyone with Type 1 diabetes?

The insulin pump is an exciting piece of technology, but it’s not for everyone. If you are wondering whether a pump would be a good idea for you or your child, discuss this healthcare team or why not check out our Facebook page and ask some of our friendly current insulin pump users what they like and dislike about it and how it impacts on day to day life. 

Whether deciding to pursue insulin pump therapy or remaining on multiple daily injections the most important thing is that you find the method of treating diabetes that works best for you/your child by reading up, chatting to others and also chatting with your Health Care Professional team.

For a list of things to things to think about when considering insulin pumps, see “Before You Start Insulin Pump therapy” from our Resources Page (link)


What can I do if I’ve been refused access to Insulin Pump Therapy?

If you meet the current NICE criteria (TA151) for insulin pump therapy is it unlikely that you will be refused insulin pump therapy if you live in Wales, although, sometimes due to staffing and resource issues and or your training requirements it may take a short while before you actually start on therapy. If, however you are told that you are not suitable for Insulin Pump therapy and you disagree please contact our friends at INPUT (http://www.inputdiabetes.org.uk/ )who can advise and advocate on your behalf if necessary.

Who are INPUT? Contact Input
INPUT’s Mission Statement: Our mission: to help people access diabetes technology and support from the NHS – including insulin pump therapy, smart glucose meters and continuous glucose monitoring. We can help you find out what’s available in the UK, if it might help you and how to access it. INPUT is a UK charity run by insulin pump users and their families. Website: http://www.inputdiabetes.org.uk/
Contact Form: Web Contact Form
Telephone (answer service): 0800 228 9977

What about Insulin Pumps for people living with Type 2 diabetes?

At the present time, the current NICE guidance (TA151) states: “Insulin Pump Therapy is not recommended for people with Type 2 diabetes”. If you have Type 2 diabetes please discuss what treatment options are available.