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    Pumping in the UK


    So, you've arrived at diabetesforums.com and found all these Americans who love their insulin pumps. So no doubt you now want one, and you're probably fuming that the NHS hasn't offered you one. Obviously you've got loads of questions, so here's a few answers to the most common ones.


    What is an insulin pump?


    It's a small electronic device with some tubing that connects to your body. Throughout the day it releases a small, steady flow of insulin, which is your basal insulin. Then when you eat, you set it to give you a larger flow of insulin for a short period of time - this is your bolus insulin.


    That's a really basic description, ask a pumper for more details.


    I want one!


    Good for you. Go get one then.


    But I live in Britain! Because of our stupid backwards healthcare system I can't get one! Why can't we be more like the much better American system?




    There is absolutely nothing stopping you getting a pump if you live in the UK. Pumps are just as easily available as they are in the United States and your care team isn't going to stand in the way of you getting them.


    It is perfectly easy to get a pump in the UK. It's just that you won't get them free on the NHS unless you meet certain criteria. However, there's absolutely nothing stopping you getting a pump through private insurance such as BUPA, or even just buying it yourself. Which is exactly what they do in the States.


    Incidentally, don't forget that the 'backwards' health service we have in the UK gives you insulin pens (which is more than what most Americans get) and all your prescriptions for completely free.


    That's stupid. Shouldn't the NHS provide pumps for free?


    In an ideal world, yes. Unfortunately, pumps cost anything up to £4000, which is a lot to spend on treatment. That's what our American pumpers tend to have to pay too, so it's not as if we're being ripped off.


    So it's a lot of money, and the NHS (like anyone else) has to make sure it's getting value for money. Dishing out pumps to everyone with diabetes isn't good value and isn't necessarily helpful. For a start, a pump will be of no use to you unless you really know what you're doing when it comes to treating your diabetes. Otherwise it's rather like buying a jet fighter and then using it to taxi down the road to the shops. Sure, it'll work, but you could have acheived much the same results by walking.


    Secondly, the principles of the pump are pretty much the same as those for multiple daily injections (MDI). Sometimes you'll also hear MDI referred to as the '4-a-day' system or something similar. It's actually incorrect terminology - under MDI you inject when you eat, so that could mean 4 times a day, or it could mean 3, or 6...you get the idea. Anyway, MDI mimics the science behind pump treatment and as a result can acheive just as good results. Unless you have particularly pronounced Dawn Phenomenon or a massively fluctuating basal insulin requirement, you can get A1c in the 6s and even in the 5s. So from an NHS perspective, why spend at least £4000 on a treatment that they can do for under £100?


    However, the NHS does also provide free pumps.


    Say that again? I can get a free pump on the NHS? How?


    Individual NHS regions have their own criteria for pump selection. Informally though, if you fall into all of the following, you are a good candidate for a free pump:


    1) You are having serious control problems with MDI.

    You are having frequent hypos, swinging wildly between lows and highs, and/or are suffering from severe hypo unawareness.


    2)You are competant in the theory of treating your diabetes

    You are able to carb count and have been on a DAFNE course or similar. You also are able to provide regular, reliable BG results from testing at least 4x a day. You are able to correct high blood sugar with an appropriate amount of insulin and are able to identify your correction factor ie. by how many mmol/l 1u of insulin will lower you.


    3)You've tried all the other forms of MDI

    You're still having serious BG control problems and have tried Insulatard, Lantus and Levemir with no success. Or you've had some sort of problem with all 3 insulins, for instance too many hypos with Insulatard, an allergy to Lantus, and poor control with Levemir.


    If you meet all three of the above, you MAY be eligible for NHS provision of a pump. I'd also suggest that a good personal relationship with your care team will go a long way to swinging the decision in your favour. Your care team needs to be able to trust you completely - this means you have to work with them and be open about your treatment regime and lifestyle. Being aware of things like Dawn Phenomenon and the Somogyi Effect will help increase their respect for your understanding.


    Therefore it is perfectly possible to get a pump in the UK (if you can fund it yourself), and it is also possible to get one provided for you.


    REMEMBER: A pump is not a right, it's a privilege.

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