How can I get a insulin pump?

[Nance1]

Hello! I've had diabetes for 35 years and have always been very brittle. I have lipohypertrophy on my stomach from years of injections and am now developing some on my thighs. Find it incredibly difficult to control my glucose levels but trying my hardest after getting my last HbA1c results (not good).
I'd love to have a permanent glucose monitor - are they available on the NHS?
Also an insulin pump. I believe both these machines would change my life!
Would these points be enough to be eligible for a pump etc? TIA

 

[Juicyj]

Hi @Nance1 The best person to ask is your Diabetes Nurse, when I decided I wanted to try a pump she was my first call and we talked through the reasons behind it which once discussed I knew I could meet the NICE criteria, she then put me forward to the CCG trust board and I was rejected at the first hearing, but persisted and was accepted at the second hearing, the process took just under a year. Please note that they will require you to of completed DAFNE (Dose Adjustment for Normal Eating - 5 day course) first too. It does vary between each CCG as they all have their own criteria but your nurse will talk you through this. Most CCG's also fund the Libre, mine doesn't so I self fund the Dexcom G6.

When I was on multiple injections my HbA1c was around 56-59, since using the pump/G6 my HbA1c is now 42, both instruments when used well can certainly benefit your control, but please don't give up on pushing your team if you feel you would benefit as they will support you but it does take some pushing

 

[Juicyj]

Have attached this information too @Nance1 I cannot comment on your eligibility as it's down to your CCG, however do start with your nurse and see what they say, in my opinion you should be eligible but I don't hand pumps out !

https://www.nice.org.uk/guidance/ta151/resources/insulin-pump-therapy-for-diabetes-pdf-374892589

 

[Deleted Account]

Hi @Nance1
As @Juicyj says, the process varies per CCG ... and the DAFNE course (or equivalent) varies per CCG.
There are criteria for pumps and criteria for Libre (other CGMs are less common). Your DSN should be able to talk you through these criteria.
To get the most out of them requires effort and training so, I am pretty sure one of the unwritten criteria is the perceived ability to be able to manage the pump and analyse the Libre data.

The criteria for the pump and Libre do overlap ... but not in a good way. For my CCG, the Libre is seen as a possible route to improve Hb1AC without a pump. So, if you get a Libre, it may mean your chance of a pump may be less.

The INPUT charity used to help with diabetes tech in the UK. They have now been merged with JDRF who have some useful information on their website such as this (https://jdrf.org.uk/information-sup...therapy/can-i-get-an-insulin-pump-on-the-nhs/) which talks through how to get a pump.
There may be similar pages about CGM.

 

[MeiChanski]

Hello @Nance1, I agree with what has been posted. However my case is a bit different to what @helensaramay has said - my hba1c is good on paper (6.4%) but my BG is very erratic too. I've been prescribed the libre sensor by my consultant for 6 months to see how things are with different ratios. You'll need to speak to your consultant about the libre, a pump and a carb counting course, if i'm correct in saying that there are a lot of T1s struggling to get a pump or libre sensor. It's all down to your CCG.

 

[Deleted Account]

Hey @MeiChanski
How does your case differ? I meant it to be included in what I wrote and if it isn't I'd like to clarify.
There are times I write too fast and miss a few don'ts or nots or something.

 

[MeiChanski]

Hey @MeiChanski
How does your case differ? I meant it to be included in what I wrote and if it isn't I'd like to clarify.
There are times I write too fast and miss a few don'ts or nots or something.

Well my hba1c is good pre and post libre sensor, the only changes are is less hypos and regain some hypo awareness back. if OP were to get a sensor and hba1c improves without a pump based in their CCG, which as you said may lessen her chances of getting a pump. My case is different because consultant will consider the pump route if things don't improve, in spite of different ratios and different insulins. So people with good hba1cs could still argue for a pump because there are other criterias or reasoning other than a high hbba1c?

 

[LooperCat]

I got a pump with a good HbA1c of 43 (few hypos) because I had to put in a ridiculous amount of work to achieve it - up to 18 corrections a day, setting alarms twice in the small hours each day to correct for dawn phenomenon... My team felt that it was detrimental to a normal life to have to do that.

 

[Deleted Account]

Well my hba1c is good pre and post libre sensor, the only changes are is less hypos and regain some hypo awareness back. if OP were to get a sensor and hba1c improves without a pump based in their CCG, which as you said may lessen her chances of getting a pump. My case is different because consultant will consider the pump route if things don't improve, in spite of different ratios and different insulins. So people with good hba1cs could still argue for a pump because there are other criterias or reasoning other than a high hbba1c?

Gotcha.
It is true there are various criteria.
For example, I got a pump first in order to reduce hypos whilst exercising. And recently got the LIbre because I was finger pricking more than 8 times a day ... with justification.

 

[EllieM]

For example, I got a pump first in order to reduce hypos whilst exercising. And recently got the LIbre because I was finger pricking more than 8 times a day ... with justification.

I should probably start my own thread on this, but I have real issues with exercise (and time of day) causing variable insulin sensitivity. I'm pretty sure I'd be given a pump if I asked, but after a bad experience with the libre am desperately trying to avoid a permanently attached device. Like @Nance1 I have issues with injection sites so I'm struggling to tell whether my recent drastically reduced insulin needs are caused by
1) more care with sites
2) abolition of cheese as a snack (sigh)
3) slightly more exercise
But in any case I'm sick of having to chomp down glucose tablets every time I go for a long walk (which is most days , as I have an Australian kelpie, which is a cross between a border collie and a dingo), when my total daily carbs are less than 100g.

And I get through 50 testing strips a week....

So do you think a pump would help?

Edited to add - and I lose hypo awareness if I keep my blood sugar running in the 4s for too long.

 

[Deleted Account]

@EllieM my pre-pump experience with exercise was
- hypos during and after a cardio gym session
- very high BG during climbing (I would start around 4.5, take a unit of fast acting insulin and be at 12 within an hour) followed by overnight hypos

The temporary and variable basal have helped me avoid highs and lows during exercise.
I am running further and for longer without hypos which allows me to follow with weights that I am lifting heavier ones.
I am climbing harder routes without getting exhausted due to too high BG.

Getting the right temporary basals and changing to them at the right time has taken a lot of trial and error but my diabetes and my exercise has greatly improved with a pump. And has eradicated the needs to carb load before the gym.

I still test a lot - before the Libre I was using 60 to 70 test strips a week. I now use less but still test with finger pricks during and after exercise because exercise can still cause my BG to change too quickly for the Libre.

I assume the problems you have had with the Libre are reactions to the glue. I think this is less common with a pump. It may be the glue they use but it is also only in one place for 3 days rather than 2 weeks.