In order to receive NHS funding, you will need your consultant’s recommendation for pump therapy.
Step-by-step guide to insulin pump access
Step 1: Speak to your diabetes specialist team or consultant at the hospital clinic
According to the NICE technology appraisal on insulin pump therapy (TA 151), only a specialist team, normally including a doctor with a specialist interest in insulin pump therapy, can decide whether or not you are suitable for insulin pump therapy – not just
your GP. If you don’t have a diabetes specialist team, ask your GP to refer you to a pump-friendly clinic.
Demonstrate your commitment to good diabetes control
• You adhere to multiple daily injections (MDI, 4 or more injections/day)
• You check your blood glucose 4 or more times/day and act on results
• You count carbohydrates and adjust mealtime insulin doses
• You adjust insulin for exercise, illness, stress
• You keep and review diabetes self-care logs
Step 2: Find out if you meet NICE criteria for NHS funding
NICE criteria, Technology Appraisal 151 (2008)
Only applicable to type 1 diabetes (there is insufficient evidence to routinely recommend pumps in type 2 diabetes, except for individual cases)
• Under 12 years old: MDI is inappropriate or impractical
• Aged 12 or older: hypos occur frequently or without warning, causing anxiety about recurrence and a negative impact on your quality of life
OR your HbA1c is still 8.5% or above despite carefully trying to manage your diabetes, including the use of Lantus or Levemir
If you meet the NICE criteria and your consultant recommends pump therapy, the Clinical Commissioning Group (CCG) cannot refuse to fund it on grounds of cost
If you don’t meet the NICE criteria but you do fall under recommendations from the Association of British Clinical Diabetologists (ABCD), your clinic will need to make a strong case for you to be granted funding
ABCD recommends that insulin pump therapy is also considered in the following situations:
• Acute painful neuropathy or symptomatic autonomic neuropathy if
conventional treatment fails to enable adequate blood glucose control
• Hypoglycaemia unawareness
• Extreme insulin sensitivity
• Needle phobia
• Severe insulin resistance with poor blood glucose control
(especially if type 2)
• Specific quality of life issues:
– Pathological fear of hypoglycaemia
– Marked glycaemic excursions/dawn phenomenon
– Excessive number of injections for optimised control
– Impaired exercise capacity, abnormal eating behaviour or an unacceptable number of sick days
– Shift work or frequent travel across time zones
– In children: sub-optimal school performance, exclusion from aspects of a full school life; behavioural problems (for example, mealtimes); adverse impact on family dynamics
Your consultant agrees you have a clinical need for an insulin pump and have the necessary commitment and skills to use the technology safely and effectively
Step 3: Identify any educational needs
You may need to learn more about diabetes management in order to receive a consultant’s recommendation for pump therapy
Some hospitals require pump candidates to take a Dose Adjustment for Normal Eating (DAFNE) course or similar training, but NICE only specifies ‘structured education’. You may have to wait up to a few months for training, depending on staff resources.
You can start learning to carb count at home, using resources listed here
If you meet the NICE criteria but your consultant does not think you are suitable for pump therapy:
1. Ask lots of questions – why do they think you are unsuitable? What changes do they think will improve your diabetes control without a pump? Is there another consultant in the clinic who is more familiar with pump therapy?
2. Consider their decision – is the consultant’s assessment fair and sensible? Do suggestions for improved control seem realistic and practical? Do you have unrealistic expectations?
3. Ask your GP to refer you to a pump-specialist clinic – you have the right to ask your GP to refer you to any NHS hospital for a second opinion. If they won’t, contact INPUT or your MP for further help and advice
Step 4: Funding is arranged
Your diabetes care team will write to the local health commissioners regarding funding, and arrange your pump training.
Contact INPUT if you need to get involved because funding is refused
− You will not normally be allowed to buy the pump yourself and then obtain NHS funding for consumables
− Continuous glucose sensors that may be available separately are not currently routinely funded by the NHS and funding has to be applied for on an individual basis
Step 5: Find out from your care team when you will be trained, and prepare to start your new therapy
Ongoing learning is an important aspect of living with pump therapy, particularly within the first few months. By connecting with experienced pump users online or in person, you can benefit from helpful advice and support.
Recommended books at the bottom of this page