Arguments for having a pump prescribed

[Mungobean]

Hi, I am really keen to try a pump, preferably the Omnipod. My consultant mentioned having to do a course. What arguments or tips have others used, in order to get a pump prescribed.

thanks in advance

Bean

 

[In Response]

I am sure this sounds harsh, but if you are looking for arguments to have a pump, you don't need one.
Are you struggling to manage your diabetes with injections in any way? Do you need the ability to adapt your basal throughout the day? Do you need smaller bolus doses? Have you done any research into the benefits of having a pump and considered how that would improve your life? Have you review the NICE guidelines for a pump?

Like many, I was required to go on a course (the local equivalent of DAFNE) but this was to ensure I was carb counting and, I suspect, for the DSN who was taking the course to assess whether I would be able to manage the added complexities that come with a pump and that MDI was second nature to me so I could calmly revert back under the stressful situation when the pump fails.

Remember, a pump is an expensive piece of kit and the NHS has limited funds so, unfortunately, they need to limit the number of people that it is available to.
Also bear in mind that different pumps are available at different clinics. Omnipod is not an option at my clinic, for example, and I had to make a very strong case to go off piste away from the standard Medtronic they offered to everyone else.

 

[Chas C]

I'd been IDD for around 30+ years before I'd got a pump, I sugar surfed (injecting for carbs and glucose levels as needed), I'd done DAFNE courses. But when I agreed to move onto a pump I was made to do the local DAFNE course again, pretty sure most teams require this. Not sure you can really argue not to do this as mentioned above.

 

[Rokaab]

Hi, I am really keen to try a pump, preferably the Omnipod. My consultant mentioned having to do a course. What arguments or tips have others used, in order to get a pump prescribed.

Just a query, why do you think you need a pump?

FYI: I knew exactly why I needed a pump and had the libre data to back it up - I still had to fight for years to get approved

 

[sleepster]

I'd been diagnosed about 15 years before I was offered a pump, my team decided I needed one.
Whilst I want to say no argument was needed in my case, it minimises how difficult it is to get a pump and how bad things had to get for me to be offered one. I joke that I had to almost die to get a pump, but that's not too far from the truth.
I didn't have to do any courses (DAFNE or otherwise) but I really wish it had been a requirement, I have never done a DAFNE and I've been asking for probably about 4 or 5 years now and still haven't been able to do it.

 

[Chas C]

I'd been diagnosed about 15 years before I was offered a pump, my team decided I needed one.
Whilst I want to say no argument was needed in my case, it minimises how difficult it is to get a pump and how bad things had to get for me to be offered one. I joke that I had to almost die to get a pump, but that's not too far from the truth.
I didn't have to do any courses (DAFNE or otherwise) but I really wish it had been a requirement, I have never done a DAFNE and I've been asking for probably about 4 or 5 years now and still haven't been able to do it.

That's quite shocking that a team would not put you on a carb counting vs insulin dosing training course, they do have different names in different teams, not sure it had a name when I first did one, our local team runs one called BERTIE (pretty much identical to DAFNE).

 

[sleepster]

That's quite shocking that a team would not put you on a carb counting vs insulin dosing training course, they do have different names in different teams, not sure it had a name when I first did one, our local team runs one called BERTIE (pretty much identical to DAFNE).

I had just moved to that hospital, they did require me to prove I could carb count by dividing a pile of plastic food into 'has carbs' and 'doesn't have carbs'! I'm at a different hospital now and I am on the waiting list to do DAFNE but y'know...covid.

 

[Mungobean]

Just a query, why do you think you need a pump?

FYI: I knew exactly why I needed a pump and had the libre data to back it up - I still had to fight for years to get approved

Hi, I struggle with my sugars because I don’t eat normally. I have Gastroparesis and so if I do eat, the food takes a variable amount of time to hit my system. I am mainly fed by tube into my bowel, and if that’s all I do, then my sugars are ok, but if I do eat anything, things that dissolve easily are the easiest for me - basically carbs; a piece of toast or a biscuit. I give some Novorapid if I do eat, but if the food takes a long time to get through into my system, I end up going low, and then high when the sugar finally hits my system. I’m not sure that a pump per se will real help me, but more a closed loop system. The diabetic nurse thinks a pump might help and so has booked me an appointment with the consultant.

You might say that the easiest solution is to stick to my tube feed - I agree, but the amount of pain this gives me - I struggle to get enough feed in so I am constantly starving and sometimes my inner pig just jumps in!

 

[Juicyj]

Hello @Mungobean Have you discussed this yet with your DSN ?

I think if you have a DSN on your side then the battle is half won already, they have to submit your case to the hospital board for funding and your DSN would fight for you to get approval so you stand a much better chance with a good relationship there.

 

[Mungobean]

Hello @Mungobean Have you discussed this yet with your DSN ?

I think if you have a DSN on your side then the battle is half won already, they have to submit your case to the hospital board for funding and your DSN would fight for you to get approval so you stand a much better chance with a good relationship there.

Yes, she is on my side.

 

[derivadow]

Hi, there are published criteria (see https://www.diabetes.co.uk/insulin/Getting-an-insulin-pump.html) but as others have said it requires DSN support + the funding board's approval (at my Trust a pump specialist nurse reviews each patient's circumstances, discusses pros and cons before submitting the application).

FWIW I keep very good records e.g. logging all injections and carbs and I think this helped in my case. I assume from what you've said the same would be true in your case (you could demonstrate the Hypos/ Hypers following food). I suspect a pump would help because you can adjust how the insulin is delivered e.g. delivered over an extended period of time. I would also hope that they would take into account the level of anxiety and distress associated with your existing regime.

I didn't need to go on a course before I received a pump because I was able to demonstrate that I was already carb counting etc.

 

[johnpol]

I'd been diagnosed for 20yrs before I was offered a pump, and I suspect it was because my diabetes was getting more complicated. I had read about them but didn't want one, but my professor said I needed it. Did the DAFNE course, but the nurse who led it ended up saying I knew what I was doing (debatable even now) and said I could cope with the complexities of the pump.