In order to receive NHS funding, you will need your consultant’s recommendation for pump therapy.
A step-by-step guide to insulin pump access
Speak to your diabetes specialist team or consultant at the hospital clinic. According to the NICE technology appraisal on insulin pump therapy (TA 151), only a specialist team, normally including a doctor with a specialist interest in insulin pump therapy, can decide whether or not you are suitable for insulin pump therapy – not just your GP. If you don’t have a diabetes specialist team, ask your GP to refer you to a pump-friendly clinic.
Demonstrate your commitment to good diabetes control which involves:
• You adhere to multiple daily injections (MDI, 4 or more injections/day)
• You check your blood glucose 4 or more times/day and act on results
• You count carbohydrates and adjust mealtime insulin doses
• You adjust insulin for exercise, illness, stress
• You keep and review diabetes self-care logs
Find out if you meet NICE criteria for NHS funding:
NICE criteria, Technology Appraisal 151 (2008)
This is only applicable to type 1 diabetes (there is insufficient evidence to routinely recommend pumps in type 2 diabetes, except for individual cases).
• If the person is under 12 years old and multiple daily injections are inappropriate or impractical, or
• If the person is aged 12 or older and hypos occur frequently or without warning, causing anxiety about recurrence and a negative impact on your quality of life
OR your HbA1c is still 8.5% or above despite carefully trying to manage your diabetes, including the use of Lantus or Levemir
If you meet the NICE criteria and your consultant recommends pump therapy, you have a right under the NHS Constitution to access it on the NHS.
Association of British Clinical Diabetologists recommendations
If you don’t meet the NICE criteria but you do fall under recommendations from the Association of British Clinical Diabetologists (ABCD), your clinic will need to make a strong case for you to be granted funding.
ABCD recommends that insulin pump therapy is also considered in the following situations:
• Acute painful neuropathy or symptomatic autonomic neuropathy if conventional treatment fails to enable adequate blood glucose control
• Hypoglycaemia unawareness
• Extreme insulin sensitivity
• Needle phobia
• Severe insulin resistance with poor blood glucose control (especially if the person has type 2 diabetes)
• Specific quality of life issues:
- Pathological fear of hypoglycaemia
- Marked glycaemic excursions/dawn phenomenon
- Excessive number of injections for optimised control
- Impaired exercise capacity, abnormal eating behaviour or an unacceptable number of sick days
- Shift work or frequent travel across time zones
- In children: sub-optimal school performance, exclusion from aspects of a full school life; behavioural problems (for example, mealtimes); adverse impact on family dynamics
Your consultant agrees you have a clinical need for an insulin pump and have the necessary commitment and skills to use the technology safely and effectively
Identify any educational needs. You may need to learn more about diabetes management in order to receive a consultant’s recommendation for pump therapy. Some hospitals require pump candidates to take a Dose Adjustment for Normal Eating (DAFNE) course or similar training, but NICE only specifies ‘structured education’. You may have to wait up to a few months for training, depending on staff resources.
You can start learning to carb count at home, using various educational resources.
If you meet the NICE criteria but your consultant does not think you are suitable for pump therapy:
1. Ask lots of questions – why do they think you are unsuitable? What changes do they think will improve your diabetes control without a pump? Is there another consultant in the clinic who is more familiar with pump therapy?
2. Consider their decision – is the consultant’s assessment fair and sensible? Do suggestions for improved control seem realistic and practical? Do you have unrealistic expectations?
3. Ask your GP to refer you to a pump-specialist clinic – you have the right to ask your GP to refer you to any NHS hospital for a second opinion. If they won’t, contact Input:JDRF or your MP for further help and advice
Funding is arranged. Your diabetes care team will write to the local health commissioners regarding funding, and arrange your pump training.
If you meet the NICE criteria and your consultant recommends pump therapy, funding cannot be refused. Please contact Input:JDRF if funding is refused.
- You will not normally be allowed to buy the pump yourself and then obtain NHS funding for consumables
- Continuous glucose sensors that may be available separately are not routinely funded by the NHS
Find out from your care team when you will be trained, and prepare to start your new therapy. If you have to wait longer than six months, ask why and contact us.
Ongoing learning is an important aspect of living with pump therapy, particularly within the first few months. By connecting with experienced pump users online or in person, you can benefit from helpful advice and support – and ask what books they recommend!
Need more help/have further questions? Ask Input:JDRF