This page answers some of the Frequently Asked Questions about pump. If you cannot find the answer to your questions please feel free to discuss therapy with the team if you would like more information.
What is an Insulin Pump?
An insulin pump is a machine that is worn and, as the name suggests, "pumps" insulin into the body through a plastic tube called a "cannula". Basically a pump does the same job as an insulin pen, but because the pump is attached to the person all of the time it means that fewer injections are needed.
Pumps have changed a lot in the last few years and most are now able to use Hybrid Closed Loop (HCL) technology. This is when a Continuous Glucose Monitor (CGM), also worn on the body, measures the glucose levels and sends this information to the pump. The pump can then adjust how much insulin it gives based on the glucose and whether it is rising or falling. It’s clever stuff.
Why do I have to wait on a waiting list?
Put simply, because more people want the HCL pumps than we can provide. We have an ambitious target to give HCL to anyone who wants it over the next 5 years but with over 800 patients attending our service it is simply not possible to do this all at once. We recognise that it will be frustrating to have to wait but with patience it will come to you.
How is training for pump therapy organised and how long does it take?
In most cases training takes place in groups of 4 families, and usually over 2 days. The first day is to learn the principles of using the pump. A family member will often wear a pump over the weekend (don't worry, there's no insulin in it!) to practice these skills, and then on the second day the young person will "go live" on their pump.
But the training doesn't end there. Over the next few days, one of the team will keep in close contact before seeing the family again to supervise the cannula being changed and can discuss some other aspects of pump therapy. This particular appointment usually only takes about 1-2 hours.
The final piece of training takes place about 6 weeks after starting on the pump. The families return for a half-day group session to go over some of the more advanced features of pump therapy.
There is quite an investment of time for everyone - both families and the diabetes team - to start people on an insulin pump. It's certainly not something we feel can be rushed.
Does this mean injections will never have to be given again?
No. When things are going well, no normal insulin injections with a pen or syringe are required. However, if the blood glucose goes high and ketones are present, it is important to have insulin by injection until you have sorted out whether the pump is working properly. Also, you may want to have a break from the pump (e.g. for a holiday) so have to go back to pen injections for a while.
I've heard insulin pumps can be dangerous. Is this true?
While properly managed pump therapy can be very effective and is safe, lax practices can be dangerous. Unlike injected insulin , which remains active for some time, a pump delivers only "fast-acting" insulin like NovoRapid and only usually in small amounts. This means that if there is a problem with the pump, for example a blockage in the cannula, the blood glucose can rise quite quickly. It's important to keep an eye on the glucose levels, check for ketones when they are too high, and deal with them before they make you unwell.
How much does an insulin pump cost?
The average cost of an insulin pump is around £2500-3200 with annual supply costs (excluding insulin) of about £1500. This cost is covered by the NHS, so you don't have to pay! We do, however, ask that you add your pump to your home contents insurance, as we've had situations before when people have lost their pump and want the NHS to give them a new one.
What if I change my mind about the type of pump I want?
Once someone has started on pump therapy, there is no scope to change to a different pump until that pump has reached the end of its warranty. For most pumps the warranty lasts for 4 years and we would normally "upgrade" pumps at some point between Year 4 and Year 5. So essentially this means that people will wear the same pump for 4 to 5 years.
Once I start on an insulin pump, do I stay on pump therapy forever?
If a pump works well for a patient and family and diabetes control is good then pump therapy will continue but some people will decide that they no longer wish to be on a pump. They can return to pen injections at their request. Sometimes they ask for a "pump holiday" of a few months, and this is often a good thing as it allows them to reassess what they liked and didn't like about the pump.
Additionally, and where the pump has been supplied by the NHS, if the clinical outcome is unsatisfactory e.g. poor control, inadequate monitoring, etc., the team reserves the right to withdraw the pump. Such a step would not be taken without prolonged discussion with the family and strenuous efforts to improve the situation.
I've seen a different pump advertised and would prefer it to one you currently offer. Can I buy it myself?
We cannot support pumps that have been self-funded in any way.
There are different makes of insulin pumps. Which ones can be offered?
At the moment, the diabetes team can offer 3 different insulin pumps, though it should be noted that not all pumps are suitable for everyone. Some pumps, for example, cannot give a small enough infusion of insulin. Others may not be able to hold enough insulin to last a full 3 days. The specifics can be discussed with a family during the pre-pump assessment period, at the point where the family can choose from those pumps on offer. These are the pumps we currently provide (shown in alphabetical order):
I already have an insulin pump but haven’t been given a Continuous Glucose Monitor. When will I get one?
We have a programme of upgrading insulin pumps when they are no longer covered by the manufacturer’s warranty. You will be offered CGM when this happens. If you already have a pump that can connect to CGM, we may be able to provide CGM sooner but it’s important to know that this will only happen if there is capacity within the service to do so.
We have a separate section of FAQ's about CGM here.
How do I know if the settings that are programmed into the pump are correct?
In just the same way as with injections, looking at and responding to the glucose results is important. The same principles apply. A family should review their results at least a couple of times a week and decide if changes need to be made. We understand, however, that making changes to insulin doses (on injections as with pumps) can be daunting, especially at the beginning, and so we can help with this when you get stuck.
Data from the insulin pumps can be uploaded to the web-based applications and you should allow sharing of this data with the diabetes team, so that we can see the same things you can see.
This link here will take you to a page with more information on sharing data.
If I am admitted to hospital, can I keep using my pump?
In most cases, the answer to this question is "yes" but it does depend on two things: 1) how unwell you are, and if your condition can be looked after safely on the pump; and 2) if an adult who knows how to use the pump can stay with you and takes full responsibility for using it during the admission. The nurses in the ward have not been trained on how to use the pump and so if an adult cannot stay you will either need to go back on to injections or have insulin given through an intravenous infusion (what some people call a "drip").
It sounds good. Can I have one?
Yes you can! There is a waiting list for insulin pumps so if you are interested your name can be added to this waiting list. When your name is close to the top of the list, a member of the team will contact you to chat about the different pumps and then carry out a “pre-pump assessment.” This assessment should not prevent you from getting a pump; it’s simply there to make sure you know what you need to know before we arrange for you to receive training on how to use the pump. If problems are identified during the pre-pump assessment, they may need to be addressed before a training date is arranged.
In some cases, an insulin pump is required right away due to urgent clinical need (e.g. in the case of a baby where it is not possible to manage diabetes safely in any other way) and if this is the case the team will be in touch and explain this to your family.
Medtronic 780G
Omnipod 5
Tandem t:slim X2
The pump can’t do everything by itself, though. For example, it doesn’t know when someone is about to eat. The person wearing the pump must still tell it how many grams of carbohydrate they are going to eat. The pump can then work out a “bolus” of insulin to match with the food.
