What is insulin pump therapy?
Insulin pump therapy is also known by the longer name of continuous subcutaneous insulin infusion (CSII). This longer name sums up what an insulin pump does - it continually infuses insulin into the subcutaneous tissue (the layer of tissue just beneath the skin).
Most insulin regimes are based on a long-acting insulin combined with a smaller amount of faster-acting insulin, all normally taken via two or more injections a day. Insulin pumps work by delivering a varied dose of fast-acting insulin continually throughout the day and night, at a rate that is pre-set according to your needs. And, because the insulin is fast acting, when you eat you can quickly give yourself an additional dose by pressing a particular button on the pump. Because the dose can be changed in this way, the pump mimics the availability of insulin from the pancreas in someone who doesn't have diabetes.
An insulin pump is not a closed loop system, that is, it does not test your blood glucose levels or work out how much insulin to deliver. You must learn to set the insulin dose yourself according to your diet, activity and blood glucose levels. It is recommended that people using an insulin pump test a minimum of four times a day, to give them the information they need to set an appropriate insulin dose. An insulin pump involves a lot of work therefore and requires a high level of motivation from the person using it.
The advantage of insulin pump therapy is that for some it can help improve diabetes control and minimise the frequency of hypos. It can also give you more freedom in day-to-day life with your insulin, diet and activity levels.
How big is an insulin pump?
Pumps are about the size of an average mobile phone. They run on batteries and have safety features to warn you if the power is running low, or if you are running out of insulin.
How would an insulin pump attach to my body?
Pumps can be safely and discretely attached in lots of different ways, such as to a belt or the waist of trousers. They can also be placed in a small bag that is attached to the arm or leg, if the insulin is being administered via these sites.
Running from the pump is an infusion set, which is a thin plastic tube with either a small needle or soft plastic cannula (a very thin and flexible plastic tube) at the other end. The needle or cannula is inserted under the skin and can usually be left in for two to three days. After this you must insert a new infusion set into a different place on your body. It is important to rotate sites, just as you should do with standard insulin injections.
Would I wear an insulin pump all the time?
Insulin pumps are usually worn 24 hours a day. They can however be disconnected for a short time if necessary, eg during some contact sports (see below).
You should not expose your insulin pump to strong magnetic fields, such as those generated by induction cookers and hobs, and MRI equipment. They can damage the part of the pump’s motor that regulates insulin delivery, possibly resulting in over-delivery and severe hypoglycaemia. Contact your pump manufacturer for more details.
Can I exercise whilst wearing an insulin pump?
There are different types of pumps, but most can be worn safely during physical activity. The pump can be disconnected for a short time if you think it might become damaged – whilst doing contact sports for example, or when swimming (although many new pumps are now waterproof).
When disconnecting the pump, the needle or cannula stays in the body. Caps are then placed over the exposed end of the needle or cannula, to keep it clean.
Because the pump uses only fast-acting insulin it cannot be disconnected for long – a rule of thumb is one hour. Whilst disconnected, no more insulin will enter the body and the blood glucose level will gradually begin to rise.
To ensure your insulin requirements are met, you must remember to re-connect your pump as soon as you have finished the activity you have been doing. Testing your blood glucose level will enable you to see if your insulin dose needs adjusting.
Who is insulin pump therapy available for?
Your suitability for using an insulin pump has to be assessed on an individual basis, and is something that needs detailed discussion with your healthcare team. NICE (the National Institute for Health and Clinical Excellence) have published guidance on the use of insulin pumps and this includes criteria that they recommend an individual should meet before starting to use a pump.
For the full NICE guidance on insulin pumps, please see the NICE website at www.nice.nhs.uk. Diabetes UK's Position statement on pump therapy is available at www.diabetes.org.uk/pumps.
You may or may not match NICE's criteria but, ultimately, only your healthcare team will be able to determine whether an insulin pump is right for you.
Although more diabetes centres are becoming knowledgeable about insulin pumps, not all will have the necessary expertise to provide the support you'll need when using an insulin pump. If your diabetes centre does not have the experience or expertise and are not able to support you, try contacting some of the pump companies (see below).
They may be able to provide insulin pump training for you and your healthcare team together.
It is hoped that in the future all diabetes specialist centres will develop more experience in this area and be able to offer high standards of care to people with diabetes who are using insulin pumps.
I don't meet the NHS criteria for a pump and am thinking about paying for one privately. How much will this cost?
If you are not deemed suitable for an insulin pump on the NHS then the cost of funding a pump privately is considerable. Insulin pumps cost between £1000 and £3000. There are additional costs for the consumable attachments, eg infusion sets, batteries and pump reservoirs, which you may also have to pay for yourself. Consumables could amount to between £1000 and £2000 per year.
If you pay privately for a pump it is just as important to have support from your healthcare team as it is if you are given one on the NHS.
What insulin pumps are available in the UK?
A growing number of companies are producing insulin pumps. If you are interested in using an insulin pump you are advised to speak to your care team for guidance on what pump would suit you best.
A list of manufacturers and suppliers is given below. The pump models available will change from time to time as new products are brought onto the market.
Please note that Diabetes UK does not endorse or accept any responsibility for the content of external websites.
- Advanced Therapeutics (UK) Ltd
Advanced Therapeutics (UK) Ltd distributes the DANA R insulin pump in the UK.
Advanced Therapeutics (UK) Ltd Napier House
Telephone: 01926 494222 Technical support: 07775 642239 (24 hours)
- Animas UK & Ireland
Animas currently supplies the following insulin pumps in the UK: Animas 2020 & IR1200.
Animas UK & Ireland
50-100 Holmer's Farm Way
Tech Support: 0800 055 6606
- Roche Diagnostics Ltd
Roche Diagnostics Ltd currently supplies the following insulin pump in the UK: the Accu-Chek Combo pump.
Roche Diagnostics Ltd
Accu-Chek Pump Care Line: 0800 731 2291
- Medtronic Ltd MiniMed
Medtronic MiniMed supply the following insulin pumps in the UK: the Paradigm 712, Paradigm 512, Paradigm 511 and the 508 pumps.
Suite 1, Sherbourne House
Croxley Business Centre
Medtronic 24 hour support number: 01923 205167
- Ypsomed Ltd
Ypsomed Ltd currently supply the OmniPod Insulin Patch Pump in the UK. Ypsomed Ltd
Blackwood Hall Business Park
Selby, North Yorkshire
Customer Care: 0800 092 6787
Where else can I go for support and information about insulin pumps?
INPUT is a national charity with a mission to support patients by advocating for easier access to diabetes technology across the UK – from insulin pumps to smart glucose meters and continuous glucose monitoring.
INPUT Patient Advocacy website: www.inputdiabetes.org.uk
Telephone: 0800 228 9977
In addition, Insulin Pumpers UK was formed in 1997 as a voluntary organisation, providing a support forum on the Internet for pump users.
I am a healthcare professional. Where can I find out more about insulin pumps?
The pump companies will be able to provide you with further information and may well provide training.