Thinking About Insulin Pump Therapy?

Continuous Sub cutaneous Insulin infusion (CSII) or Insulin pump therapy allows a programmed continuous delivery of insulin through an external pump which can be adjusted to your individual needs.

What is an Insulin Pump?

A pump is a battery operated computerised device about the size of a pager. The pump stores and delivers insulin based on an individual's specific information. The pump can assist with the calculation of bolus doses easing any anxiety you might have about what dose to take.

What does an insulin pump do?

The pump can be programmed to mimic normal pancreatic function by delivering fast acting insulin in two ways.

Basal rate - background insulin

Bolus dose - meal time insulin

It allows for variation in food intake and different activities.

There are special functions on the pump including bolus calculator - effective in reducing nocturnal hypos and post prandial high blood glucose levels.

The pump helps eliminate 'dawn phenomenon' and is great for people who have unpredictable lifestyles. It allows an immediate response to unexpected situations.

The basal programmes can be pre-set which helps reduce anxiety.

The insulin regime can be adapted quickly to meet with changing insulin requirements including Pregnancy and illness.

Insulin pump therapy can help improve diabetes control and delay the onset and progression of diabetes complications, reduce hypoglycaemia and improve quality of life for people with diabetes.

Because of the cost of insulin pump therapy the government's National Institute for Clinical Excellence (NICE) have put together criteria for commencing insulin pump therapy.

The criteria for suitability for insulin pump therapy are:

  • Type 1 Diabetes on multiple daily injection regimes.
  • Have attended structured education in the management of your diabetes.
  • Inability to achieve target HbA1c without experiencing repeated and unpredictable hypoglycaemia episodes, resulting in anxiety and have an adverse effect on your quality of life.
  • You are committed and have the competency to use the equipment effectively.
  • Women who are preparing for pregnancy or are pregnant.

York Teaching Hospital Diabetes Unit has a dedicated Insulin pump clinic that will support you in your training and on-going management needs. This is run by a team consisting of Consultant Diabetologist, Diabetes Specialist Nurse and Diabetes Dietitian.

The York Diabetes Team have  a structured education programme for commencing people on insulin pumps and we will coach you on how to use the pump and adapt the settings for a variety of different situations.

Your commitment to insulin pump therapy will require you to do regular blood glucose monitoring and attendance at the group structured education training sessions and regular review of your diabetes management in the diabetes Insulin pump clinic.

You will need to have completed a short course in carbohydrate counting and insulin management (BITES or DAFNE are structured education sessions that are run locally) so that you can have an understanding of how carbohydrates in your food can influence your blood glucose levels.

Insulin pump therapy is not an easy option.  However if used well it can provide more flexibility for day-to-day living with diabetes.

What are the pros and cons of insulin pump therapy?

Pros!

There are fewer injections required with a pump as the pump uses a cannula which is changed every 2-3 days. There are special functions on the pump which include:

 Bolus calculator - effective in reducing nocturnal hypos and post prandial high blood glucose levels.

 The pump helps eliminate 'dawn phenomenon' and is great for people who have unpredictable lifestyles. It allows an immediate response to unexpected situations. The basal programmes can be pre-set which helps reduce anxiety.

 The insulin regime can be adapted quickly to meet with changing insulin requirements including Pregnancy and illness.

 Insulin pump therapy can help improve diabetes control and delay the onset and progression of diabetes complications, reduce hypoglycaemia and improve quality of life for people with diabetes.

Cons!

For some patients, there can be an increased risk of DKA.

Wearing a pump means that being a diabetic is "on the outside". Friends and family (and strangers) become more aware of your diabetes.

It means being permanently attached to the pump, which could have implications on body image if clothing means the pump is visible.

Blood glucose needs to be constantly monitored. Continuous Glucose Monitoring (CGM) is not available via NHS on pumps.

You will need to carry an emergency kit with you at all times, this means more supplies.

Some patients experience weight gain when using a pump.

Please use the link for further information:

Pump Comparison Document July 2017

 

For more information please contact:

Diabetes Nurse Specialists

Tel: 01904 726510

Or email : tara.kadis@york.nhs.uk

 

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