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May 11, 2006

Insulin Pumps

Question from Essex, England:

I am an insulin dependent diabetic and I would like to go on a pump. How does it works and what does it cost? Can I get it on the NHS or does it cost?


From a parent in the U.K. whose child is using a pump.

“The rules governing pump funding on the NHS goes like this:

There is a government body set up, called NICE, which stands for National Institute for Clinical Excellence. This body looks into new and existing medical therapies and decides whether it will fund the therapy, drugs, etc, if so, under what rules. For instance, some of the newest cancer drugs for breast cancer are not being funded at the moment because trials are still being done and, although they maybe effective, there are cheaper drugs available. So, they might decide only to allow this particular drug if the cancer is a particularly aggressive sort or the cancer than is likely to reoccur. The same with other expensive therapies for RA or other cancers.

With pump therapy, there is rather a long list of clinical guidelines. In general, NICE has recommended insulin pump therapy as one option for people with type 1 diabetes provided that multiple-dose insulin therapy (including using insulin glargine or detemir when it’s appropriate) has failed, and they are willing and able to use insulin pump therapy effectively.

NICE considers that multiple-dose insulin therapy has failed when someone has been carefully trying to manage their diabetes but hasn’t been able to keep their blood glucose levels within recommended levels without having “disabling hypoglycaemia.” This means that they have repeated and unpredictable hypoglycaemic episodes for which they need help from other people, and which make them anxious about the episodes occurring again and significantly spoil their way of life. See Diabetes (type 1) – insulin pump therapy (No. 57).

Basically, if a patient had repeated severe hypoglycaemic reactions that need third party assistance. Or, they are unable to keep their A1c below 7.5%, then they may be considered for a funded pump.

The two page summary guidelines are listed at Guidance on the use of subcutaneous insulin infusion for diabetes.

In reality, there are many hospital diabetes departments that do not know much about pumps and don’t want to know. Or, they are worried about the cost of funding the pumps. If your hospital is unwilling to pursue a pump, you can ask to be referred to another hospital that has a pump program. Whether you get referred might depend on whether your current consultant thinks that you fit the guidelines. Though most consultants who don’t want to know about pumps don’t really care if they send you elsewhere, because they don’t want the problems with pumping to deal with.

When you get referred to a hospital with a pump program, the consultant will then decide if you fit the criteria for a funded pump. Some consultants will “bend the rules a bit” and can make the circumstance fit, if they really want. There is a charity in the U.K. called INPUT (promoting Insulin Pump Therapy) run by John Davis who works tirelessly to promote the use of pump therapy in the U.K. He will help or advise anyone trying to get an insulin pump. It’s not that easy to get a pump, even if you can pay for it, because there are not enough hospitals that have the training and knowledge. But, this is changing.

If you want to be on a pump and are having problems, contact John Davis at INPUT and/or join Insulin Pumpers UK.”

For information on how insulin pumps work, see our web page on Insulin Pump Therapy.