Access to insulin pumps

Insulin pumps have many proven advantages, but are more expensive in the short-term than multiple daily injections

The UK has been slow to adopt insulin pump therapy with recent estimates suggesting that only seven per cent of people in the UK use one compared to 15 per cent in Germany and Norway, and over 40 per cent in the USA.

NICE technology appraisal 151 was published in 2008 and updated in late 2014. It recommends pump therapy for adult patients and children over 12 years of age with type 1 diabetes who were suffering from recurrent hypoglycaemia despite optimised multiple daily injections. NICE recommended pump therapy in adults and children over 12 years old with type 1 diabetes who had an HbA1c in excess of 8.5%. It also recommends pump therapy as a treatment option for children younger than 12 years with type 1 provided that MDI therapy is considered to be impractical or inappropriate.

If you are struggling to access a pump despite it being appropriate for you or your child, you may want to follow the steps in this guide written by INPUT.

How do you get a pump on the NHS?

You can get a pump on the NHS if you have type 1 diabetes (very few people with type 2 are funded) AND your diabetes consultant agrees that you have a clinical need for pump therapy AND:

OR your HbA1c levels have remained at 8.5% or above on multiple daily injections (MDI), despite a high level of care.

If a diabetologist recommends an insulin pump, the Clinical Commissioning Group or Commissioning Consortia cannot refuse it on grounds of cost.

Some hospitals will insist you attend a Dose Adjustment for Normal Eating (DAFNE) course, or a similar ‘structured education’ training course. If you’re waiting to go on the course, you can start learning online now on the INPUT website

Discuss it with your healthcare team

A GP cannot make a decision regarding a patient’s suitability for an insulin pump. Ask your GP to refer you to a pump-friendly clinic. There’s a list on the INPUT website or call INPUT on 0800 228 9977.

To show that you have the commitment to use a pump safely, you could:

  • Switch to multiple daily injections (MDI) (four or more injections a day).
  • Perform four or more blood glucose readings a day and act on the results
  • Count the carbohydrates you eat and adjust your mealtime insulin doses
  • Adjust your insulin dose according to accommodate exercise, illness, stress etc
  • Keep good records and review your results regularly to spot patterns that may be addressed by changing your insulin doses

If your consultant prescribes insulin pump therapy, they will arrange the funding and training. You may have to wait for training if the clinic is short of staff. Discuss timelines with your healthcare team.

What to do if your clinic says ‘no’?

Consultants might say now because they think you have unrealistic expectations about what the pump will do for you (the pump can help you manage your diabetes, but self-care is still a significant commitment). It may also be that you don’t meet the criteria shown above.

Another reason might be that your consultant or other clinical staff are unfamiliar with pumps therapy. Some myths you may hear from teams unfamiliar with pumps are that they are ‘unsafe’, ‘experimental’ or ‘not available on the NHS’.

Don’t feel defeated – ask questions!

Why do they think you are not suitable for a pump? What changes do they think will improve your type 1 diabetes control if a pump is not recommended? Did the consultant’s assessment seem fair and sensible, and were the suggestions of how to improve your control without a pump realistic and practical?  If not, is there another consultant in the clinic who is more familiar with pump therapy? If there is, ask to see them.

You may need to ask your GP to refer you to a different clinic. You have the right to ask for a second opinion from any NHS hospital, so choose a pump-friendly one. If your GP won’t refer you to your chosen hospital, contact INPUT for further help and advice.

Be aware that you cannot part-fund pump therapy under the NHS. This means you cannot buy the pump yourself and then obtain NHS funding for consumables.

For further guidance and advice on getting access to an insulin pump please contact INPUT.