An insulin pump is not suitable for everyone. You have to be motivated enough to care for your own diabetes. If so, and you meet the NICE criteria, then you are a prime candidate for a pump.
The most common reasons for recommending insulin pumps are:
- Significant highs and lows in blood glucose levels.
- Frequent low glucose levels that require someone else’s help
- A continually high HbA1C despite best efforts on injections
Children and teenagers may keep better control of their diabetes through adolescence using a pump. Female pumpers can control glucose levels more closely during the menstrual cycle and pregnancy.
Beyond strictly medical considerations, you may also thrive on a pump because it fits your lifestyle. Having a job that requires shift work or long-distance , for instance, are good reasons for considering a pump.
“Niche” indications – where you don’t strictly fit the NICE criteria but are still likely to benefit from insulin pump therapy – include hypoglycaemia unawareness, extreme insulin sensitivity or resistance, pre-pregnancy, insulin allergy or needle phobia which is causing clinical problems.
Successful pump users (or their carers) must:
- Carefully manage their own diabetes on a day to day basis.
- Count carbohydrates and adjust insulin doses to cover food.
- Check blood glucose levels at least 4 – often 7 or 8 – times, a day before eating, taking insulin, or exercising, and 2-3 hours after a bolus to ensure glucose levels are in single figures.
And if you are still in doubt about the real advantages of a pump, try doing the following on MDI!
- dealing with dawn phenomenon.
- delivering a 0.8 correction dose.
- giving a precise bolus (from a quarter of a unit upwards) to match carbohydrate intake.
- instantly reducing basal level to cover activity.
- increasing basal dose to cover illness.
Since the release of NICE guidance on insulin pump therapy in 2003, interest in insulin pumps has expanded in the UK growing from about 2000 to between 8000/ 10000 users in 2010.