There is a high level of demand for insulin pumps but currently the UK lags behind other European countries in its provision of insulin pumps
Insulin pumps allow greater opportunity to take control of diabetes but, because they are a more expensive option than injections, eligibility criteria exists to ensure the most suitable candidates have access to insulin pump therapy
Funding options
There are two main options for getting an insulin pump:
- Self funding –whereby you buy the pump and consumables
- NHS funded –the pump is paid for by the NHS for those meeting eligibility criteria
The most common option for getting an insulin pump in the UK is to have one funded by the NHS.
Getting an insulin pump privately
If you buy the pump privately, you will need to consider the total cost, including the consumables, and ensure you have a health team with a specialism in insulin pumps.
You will need to arrange whether you will be able to receive care on the NHS or privately before going ahead with buying an insulin pump privately.
Insulin pumps tend to cost between £2,000 and £3,000 and the consumables for an insulin pump, including infusion sets, reservoirs and batteries, can cost around £1,000 to £2,000 a year
The NHS does not operate a scheme in which it funds pumps which have been bought privately.
Getting a pump on the NHS
The process of getting an insulin pump can vary across different parts of the UK as budgets, the level of demand for pumps and the number of healthcare professionals with experience of insulin pumps can all play a part.
The advantage of applying for an insulin pump through the NHS is that you have the chance of getting the pump for free. This for most people outweighs the disadvantages of not knowing whether or when they may qualify for a pump.
The process can be as short as a few weeks but it can sometimes take several months or over a year.
Process
- Ensure you are in, or get transferred to, a clinic with specialists in insulin pump therapy
- Meet the criteria set out in the NICE guidelines
- Work with your health team to demonstrate dedication to achieving diabetes control
- The funding stage
- Undergoing insulin pump training
INPUT, a charity which aims to help people in the UK with gaining access to insulin pump therapy, can provide useful advice and support through the application procedure.
Get under the care of insulin pump specialists
It is important, when on an insulin pump, that you have support from a health team that has a strong understanding of insulin pumps. As a result, the NICE guidelines state that insulin pump therapy should only be started by health teams that have a doctor with a specialism in insulin pumps.
It is recommended that a dietitian and a diabetes specialist nurse are also present in health teams that are responsible for the care of people on insulin pumps. If your clinic or health team does not have the appropriate personnel, you will need to be transferred to a clinic which does.
Eligibility for an insulin pump – under 12s
The NICE guidelines state that under 12s may be suitable for an insulin pump if multiple daily injections are either impractical or inappropriate.
It’s important to note that the NICE guidelines also state that between the ages 12 and 18 years old, children will be expected to have a trial of using multiple daily injections (MDIs), if they have not been on MDI previously.
Suitability for an insulin pump – over 12s
Suitability in teenagers and adults is determined by how much people are struggling on multiple daily injections (MDIs) despite making concerted efforts to achieve good diabetes control. People that are on an MDI insulin regimen that are carbohydrate counting, testing regularly but having any of the following problems may be deemed suitable for a pump by an insulin pump specialist:
- Regular episodes of severe hypoglycemia
- Unpredictable instances of hypoglycemia that leads to significant and persistent anxiety and distress
- An HbA1c level of over 8.5% despite a high level of dedication towards achieving diabetes control
If you have good control of your diabetes and want a pump, you may still be able to get approved for a pump but priority may be given to other patients.
ABCD: Additional factors that may influence suitability
ABCD is the Association of British Clinical Diabetologists list a number of additional factors which indicate increased suitability for an insulin pump:
- Needing to take an excessive number of daily injections to achieve good control of diabetes
- Having a pathological fear of hypos
- Having wide changes in blood glucose over night (such as dawn phenomenon ) that cannot be sufficiently controlled
- Injections or difficulty with control causing abnormal eating behaviour
- Injections or poor diabetes control leading to behavioural problems
- Marked negative impact on ability to exercise caused by high or low sugar levels
- Taking excessive number of sick days as a result of diabetes control
- Needing to work significantly varied shift times
- Needing to regularly travel across different time zones
- Diabetes control affecting school performance
- Diabetes control or injections leading to exclusions from full school life
- Significant impact on family life caused by injections
- Going through pregnancy and having difficulty achieving sufficient blood glucose control
- Having type 2 diabetes with severe insulin resistance and unable to achieve blood glucose control
Demonstrate your commitment to diabetes control
Using an insulin pump requires significant dedication. You will need to test your blood glucose levels at least 4 times per day and be confident in carbohydrate counting and adjusting insulin doses for different activities.
Your health team may also require you to attend a carbohydrate counting structured education course Moving onto a pump can be a significant change so it’s important that you and your health team have no doubts over your ability to monitor and control your diabetes.
Funding
If you meet the NICE criteria for getting an insulin pump and your health team is confident you are well suited to going onto Continuous Subcutaneous Insulin Infusion therapy (insulin pump therapy), the next step for your health team is to arrange funding.
Your health team will need to write to local health commissioners to agree for funding to be provided.
Some people may face more difficulty than others at this stage depending on local health budgets. If your consultant considers insulin pump therapy to be appropriate but funding is refused, get in contact with INPUT.
Insulin pump training
Once funding has been secured, you will have a date arranged to commence training on the use of your insulin pump.
Insulin pump training can vary from a single day session to having a trial period, often for a week, with an insulin pump with saline in. Note that if you have trial with saline in the pump, you will need to take insulin injections whilst on the trial.
Will the NHS pay for all consumables?
It is common for the NHS to cover the cost of consumables such as infusion sets.
If you have a pump with glucose sensors, or a separate continuous glucose monitor, these are not provided on the NHS so you will need to buy these.
