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Inputdiabetes.org.uk

An insulin pump can help you gain tighter control of your diabetes because it allows you to adjust your insulin doses according to your body’s needs. This minimises everyday high and low glucose swings and long-term complications. Insulin doses are also much more precise than any available pen or syringe and having only rapid-acting insulin in your system can give you more stable and predictable control. Insulin pumps can offer you a better quality of life and a more flexible schedule, but this technology does require motivation for self-care. 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, normal y 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. We have a list of clinics on the INPUT website that might be a good starting point Demonstrate your commitment to good diabetes control • You adhere to multiple daily injections (MDI, 4 or more injections/day) • You adjust insulin for exercise, il ness, stress • You check your blood glucose 4 or more times/day and act on results • You keep and review diabetes self-care logs • You count carbohydrates and adjust mealtime insulin doses Step 2: Find out if you meet NICE criteria for NHS funding
NICE criteria, Technology Appraisal 151 (2008) Only for 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 careful y 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 fol owing situations: • Acute painful neuropathy or symptomatic autonomic neuropathy if conventional treatment fails to enable adequate blood glucose control – Marked glycaemic excursions/dawn phenomenon – Excessive number of injections for optimised control – Impaired exercise capacity, abnormal eating behaviour • Severe insulin resistance with poor blood glucose control – 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 skil s 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 therapySome 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 on the INPUT websiteIf 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 refusedNB:− You will not normal y be al owed 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. You will find many links to different online forums, social media and physical get-togethers on the INPUT website, as well as recommendations for books and other resources Continuous Glucose Monitoring (CGM) access
Option 1: NHS funding
Short-term use:NICE Clinical Guideline 15 (2004) states: “In type 1 diabetes… continuous glucose monitoring systems have a role in the assessment of glucose profiles in adults with consistent glucose control problems on insulin therapy• Repeated hyper-/hypoglycaemia at the same time each day• Hypoglycaemia unawareness, unresponsive to conventional insulin dose adjustment” This guideline also says: “Children and young people with type 1 diabetes who have persistent problems with hypoglycaemia unawareness or repeated hypoglycaemia or hyperglycaemia should be offered continuous glucose monitoring systems.” NB: Research shows that using a CGM at least 70% of the time is more likely to improve your HbA1c than short-term use Long-term use:• Long-term (continuous) use of CGM has not yet been technology appraised by NICE so there is no obligation for the NHS to fund it• Access to long-term CGM varies across clinics, with highly pro-active paediatric clinics being the most forthcoming • If you apply for individual funding through your consultant, your letter should explain how the NHS can save money if you use a CGM, for example, preventing ambulance cal -outs or A&E admissions 1
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Option 2: Self funding
CGM receiver + transmitter Direct purchase from contact the companies providing CGM. Contact • You are likely to get the most benefit from CGM if you have support from your diabetes team• Standalone systems can be used with any pump or MDI• It is possible to pay the initial costs of a long-term CGM system yourself and receive full or partial NHS support for the sensors The INPUT Mission
INPUT was founded in 1998 as an independent voluntary organisation by John Davis MBE, an insulin pump user.
We became a registered charity in 2013 and continue to be run by insulin pump users and their families
We aim to help any person who could benefit from insulin pump therapy, and has motivation to use it, to access it through
the NHS. Our mission is 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
Who we are
We are a registered charity with a board of trustees and an advisory board of healthcare professionals
We also have a number of volunteers who help with INPUT exhibitions and advocates who point people in our direction Please visit our website or
contact us for more information:
www.inputdiabetes.org.uk
INPUT Patient Advocacy is a charity registered in England and Wales (no. 1150609). Registered address: First Floor, 50 Brook Street, London W1K 5DR. Registered as a company limited by guarantee in England and Wales (no. 08289511).

Source: http://www.inputdiabetes.org.uk/wp-content/uploads/2013/04/Step_by_step_guide.pdf

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