Insulin pump questions?

diva19871987 · Jun 27, 2012

Hi, I am 25 years old and have had type 1 for 12 years. I have never had good control and I am always either dangerously high or dangerously low with not much in between so as you can imagine it is definitely taking its control of my overall health.

I need some information about insulin pumps within the UK. Im hoping pump users can give me some insight of the pumps.

Are pumps available on the NHS and what criteria is there for a pump? I have retinopathy, over active thyroid problems and neuropathy in my feet.

If I was put on a waiting list what would be the waiting times? I know this is probably an impossible answer to guess but what was other insulin pump waiting times?

What risks are involved with a pump?

Would an insulin pump reduce the need to test my blood sugars?

What is the operation like when a pump is fitted?

Any known pros and cons using a pump?

I have no idea about the pump but If i wasn't put on a waiting list could I pay privately or have the operations overseas?

What are the average costs to run the pump?

Thank you

dowuchyalike · Jul 3, 2012

Hi there

You've asked quite a few questions there, so I'll attempt to answer each one in turn.

1. Yes, pumps are available on the NHS. I think I'd be right in saying that the criteria for getting them differs between primary care trusts; however, as a general rule if your control is especially bad and you've already exhausted other possibilities, then you are considered a good candidate for pump therapy.

2. I don't think there's such a thing as waiting times (but I could be wrong). In my own situation, I was obliged to attend a course (1 day a week for 4 weeks) aimed at teaching carb counting and insulin dose adjustment to type 1s on all therapies. The understanding was that if after the course I still wished to pursue pump therapy then an application would be made to the PCT for the funding required to supply me with the pump. From my initial enquiry with my diabetes nurse to actually getting the pump, I think the time period was about 10 weeks.

3. As for 'risks', well, thankfully, there are not too many to worry about. Sometimes issues with cannulas or tubing can prevent insulin getting through and you may go a short time without receiving any insulin but many pumps are programmed to detect these problems and alert you accordingly. Having said that, there have been occasions when I've had high blood sugars after inserting a new cannula or when I'm on the last day of use of an existing one. Such problems are seemingly unavoidable but most of the time you're only talking about elevated glucose for a couple of hours, which is unlikely to have any serious implications for long term health if your overall control is good.

4. If anything, a pump will increase your need to test blood sugars. Most come with the ability to provide 'bolus advice' based on presetting them with details of your insulin sensitivity; however, they take into account your blood sugar at the time, so basically you have to test in order to take advantage of that facility.

5. There is no operation involved. The pump sits outside your body and can be kept in a pocket or in one of the many carrying solutions that are available. You apply a small cannula to a fleshy area of your body (usually abdomen or upper/outer buttocks), then the pump tubing connects to the cannula at one end and the pump itself at the other.

6. Pros for most people are better control, increased lifestyle flexibility and, of course, the removal of the need for injections. The fact that you can bolus in a public place without drawing any attention to yourself is a real godsend.

Cons might be the fact that the pump is attached to you all the time. You might find this a problem at nighttime or when engaging in certain activities. Personally, I think these are minor issues when compared to the benefits that the pump provides.

6. I have no idea whether you can arrange to buy one direct from a manufacturer. I'd guess not, knowing the health and safety laws in this country, but again, I could be wrong.

7. No costs whatsoever to the pump user. The primary care trust pays for all consumables, including batteries. This is certainly my experience but other pump users may have different experiences.

supergob · Jul 3, 2012

Hi,

Can anyone answer my question. I have made a request to my Consultant to have an Insulin Pump fitted, but been refused. Having heard nothing but good about the pump and having trialed a pump under supervision while in hospital for problems with kidneys due to diabetes with great success. I thought it would be a simple job to get permission to have one fitted. But it would appear that because I am a long term type two diabetic (30 years, 20 on insulin) , I do not meet the criteria. The main two reasons given are that I am a Type Two and or the fact that I use a large volume of insulin. I currently use two insulin's, one is Lantus long lasting, two injections of 60 and 70 units/ml and Nova Rapid three injections of 60/60 & 70 units/ml. At my last visit to the Consultant I again made a request for a pump and this time he did say that if I could produce any evidence of other type 2 sufferers being fitted with the pump, he would consider fitting one on me on trial. So can anyone help me direct or perhaps point me to where I can find evidence to win over a stubborn consultant.

iHs · Jul 3, 2012

Hello Supergob

My friend got an insulin pump and was type 2 - being very insulin resistant was using huge amounts of insulin every day (much more than yourself) through obesity. So much so that U500 insulin was prescribed which is 5 x the strength of U100 and that was used in a pump so that less insulin was used. You wouldn't need to use U500 but would need to re fill a pump cartridge more often than average pump user. Cartridges hold no more than 300u of insulin.

I would contact INPUT about your situation with your consultant to see if they offer any help to you. Can you make yourself less insulin resistant by eating less carb, doing more exercise or is there a medical reason for the large volumes of insulin needed?

dowuchyalike · Jul 3, 2012

supergob said:
Hi,

Can anyone answer my question. I have made a request to my Consultant to have an Insulin Pump fitted, but been refused. Having heard nothing but good about the pump and having trialed a pump under supervision while in hospital for problems with kidneys due to diabetes with great success. I thought it would be a simple job to get permission to have one fitted. But it would appear that because I am a long term type two diabetic (30 years, 20 on insulin) , I do not meet the criteria. The main two reasons given are that I am a Type Two and or the fact that I use a large volume of insulin. I currently use two insulin's, one is Lantus long lasting, two injections of 60 and 70 units/ml and Nova Rapid three injections of 60/60 & 70 units/ml. At my last visit to the Consultant I again made a request for a pump and this time he did say that if I could produce any evidence of other type 2 sufferers being fitted with the pump, he would consider fitting one on me on trial. So can anyone help me direct or perhaps point me to where I can find evidence to win over a stubborn consultant.

Supergob, I sympathise with your predicament but I think pump therapy is rarely considered an option for type 2s, most likely because in the majority of cases it isn't an appropriate regimen. I would figure the costs associated with it are also a hugely significant factor. With type 2 rapidly on the increase, the government are unlikely to adopt a policy by which they'd become available to one and all – it just wouldn't be economically feasible. As iHs points out, however, individual cases may be judged on their own merits and you may have some success if you take your case beyond your practitioner.

Best of luck.

diva19871987 · Jul 4, 2012

dowuchyalike said:
Hi there

You've asked quite a few questions there, so I'll attempt to answer each one in turn.

1. Yes, pumps are available on the NHS. I think I'd be right in saying that the criteria for getting them differs between primary care trusts; however, as a general rule if your control is especially bad and you've already exhausted other possibilities, then you are considered a good candidate for pump therapy.

2. I don't think there's such a thing as waiting times (but I could be wrong). In my own situation, I was obliged to attend a course (1 day a week for 4 weeks) aimed at teaching carb counting and insulin dose adjustment to type 1s on all therapies. The understanding was that if after the course I still wished to pursue pump therapy then an application would be made to the PCT for the funding required to supply me with the pump. From my initial enquiry with my diabetes nurse to actually getting the pump, I think the time period was about 10 weeks.

3. As for 'risks', well, thankfully, there are not too many to worry about. Sometimes issues with cannulas or tubing can prevent insulin getting through and you may go a short time without receiving any insulin but many pumps are programmed to detect these problems and alert you accordingly. Having said that, there have been occasions when I've had high blood sugars after inserting a new cannula or when I'm on the last day of use of an existing one. Such problems are seemingly unavoidable but most of the time you're only talking about elevated glucose for a couple of hours, which is unlikely to have any serious implications for long term health if your overall control is good.

4. If anything, a pump will increase your need to test blood sugars. Most come with the ability to provide 'bolus advice' based on presetting them with details of your insulin sensitivity; however, they take into account your blood sugar at the time, so basically you have to test in order to take advantage of that facility.

5. There is no operation involved. The pump sits outside your body and can be kept in a pocket or in one of the many carrying solutions that are available. You apply a small cannula to a fleshy area of your body (usually abdomen or upper/outer buttocks), then the pump tubing connects to the cannula at one end and the pump itself at the other.

6. Pros for most people are better control, increased lifestyle flexibility and, of course, the removal of the need for injections. The fact that you can bolus in a public place without drawing any attention to yourself is a real godsend.

Cons might be the fact that the pump is attached to you all the time. You might find this a problem at nighttime or when engaging in certain activities. Personally, I think these are minor issues when compared to the benefits that the pump provides.

6. I have no idea whether you can arrange to buy one direct from a manufacturer. I'd guess not, knowing the health and safety laws in this country, but again, I could be wrong.

7. No costs whatsoever to the pump user. The primary care trust pays for all consumables, including batteries. This is certainly my experience but other pump users may have different experiences.

Thank you very much! Great answers!

phoenix · Jul 4, 2012

I have certainly seen many cases of people on forums with T2 who use insulin pumps, mostly I have to say in the US though I have met one person here in France. In the US medicare will refund the costs of insulin pumps to those who have T2 and also have documented low levels of insulin production ( using a C peptide test)

Updated fasting C-peptide testing requirement:
• Insulinopenia is defined as a fasting C-peptide level that is less than or equal to
110% of the lower limit of normal of the laboratory’s measurement method.
• For patients with renal insufficiency and creatinine clearance (actual or calculated
from age, gender, weight, and serum creatinine) ≤50 ml/minute, insulinopenia is
defined as a fasting C-peptide level that is less than or equal to 200% of the lower
limit of normal of the laboratory’s measurement method

.
http://www.cms.gov/Regulations-and-Guid ... R27NCD.pdf

Here is one who has self published a book about his experiences
http://www.amazon.co.uk/Successful-Diab ... 1461143551
Perhaps better evidence is this review of the use of insulin pumps in T2 (unfortunately the evidence is inconsistent but some trial have show good results)
All the trials are referenced so you can follow them up.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924784/

The available clinical evidence on CSII for T2DM is not yet consistent. RCTs have consistently shown that CSII reduces glucose, as demonstrated by HbA1c. When compared to MDI, CSII has resulted in both equivalent and lower HbA1c values. There are not many studies available for evaluation, and they are heterogeneous in design and subject population. However, some RCTs and other studies have shown clinical benefits of CSII for T2DM, particularly with simple insulin dosing regimens. Moreover, study subjects have indicated a preference for CSII, leading researchers to speculate how insulin pump use can be expanded among people with T2DM. The use of simpler insulin pumps and concentrated insulin formulations (e.g., U-500) are products of this speculation but are still largely untested options for people with T2DM

supergob · Jul 5, 2012

Thank you for your response, I will take a copy of iHs reply and am busy reading through the various threads given to me by member. I thank you all for your input, although it shows that we the sufferers appear to have little say in how diabetes is treated and early mistakes cannot be rectified later on in life. I contest that type two ever was a Obese problem and certain synthetic insulin's assist in the creation and storage of fat by sugar conversion. I certainly had no such problems when on natural insulin, neither had I the Hypo problem that many synthetic insulin takers have today.

CarbsRok · Jul 5, 2012

supergob said:
Thank you for your response, I will take a copy of iHs reply and am busy reading through the various threads given to me by member. I thank you all for your input, although it shows that we the sufferers appear to have little say in how diabetes is treated and early mistakes cannot be rectified later on in life. I contest that type two ever was a Obese problem and certain synthetic insulin's assist in the creation and storage of fat by sugar conversion. I certainly had no such problems when on natural insulin, neither had I the Hypo problem that many synthetic insulin takers have today.

Daft question but why can't you go back to the natural insulin's if you had no problem using them?

cjw · Jul 5, 2012

FAO diva
Saw your concerns about a pump which was mostly replied to however I have a medtronic pump and a sensor attached. The sensor is also attached outside the body and does constant checks but of instital fluid rather than blood sugar so not as accurate. Blood tests needed to calibrate it. Sensor alarms at various points you set yourself eg if mine detects 4.5 it beeps or above 12. Will also beep if it spots a trend in blood sugar falling or rising. You set these ranges with assistance from DSN. Not 100% accurate but will ensure you do a blood test the minute it detects a problem. Sounds like you will qualify but as other person said different Trusts do vary.
I really think a sensor (not necessarily the one I have) will help you.
Good luck.

Insulin pump questions?

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