(Scroll to bottom for user reviews)
For many years insulin pumps were a rare novelty in the UK. But since about 2010 there seems to have been a sea-change, with many PCTs now offering them to T1s and the numbers of pumpers is swelling rapidly.
The official criteria are basically that a pump is appropriate if a T1’s attempts to reach a target HbA1c with multiple daily injections result in ‘disabling hypoglycaemia’ or HbA1c levels have remained at 8.5% or above with multiple daily injections despite the person and/or their carer carefully trying to manage their diabetes.
In practice there seems to be a bit of a postcode lottery with many consultants now seeming to act in the broadest spirit of the guidelines (eg not getting an A1c below about 7-7.5 or having a lot of hypos despite good understanding of MDI).
So for many T1s suddenly confronted with this option, the big questions tend to be: “what does a pump do?” and “which one is best?”
The answer to the former is fairly simple and uncontroversial. A pump is a pager-sized device that contains an insulin reservoir (usually refilled every few days) and from which a constant (user-variable) trickle is pumped into the body via a piece of thin tubing. The tubing leads to a canula – a device that’s pretty much a needle (in steel or flexible Teflon) about the same length as the needle used when injecting with an insulin pen. The canula stays in place for about three days before being replaced.
The huge advantage of a pump is that it can be preset to vary the flow of insulin (it only uses rapid insulin – no separate long-acting insulin is needed) throughout the day and night according to body requirements. This overcomes a problem with the traditional shot of long-acting insulin, which is released at a steady rate over 12 to 24 hours at a consistent level irrespective of whether more or less is needed at a particular time of day.
In a similar way to MDI, boluses are delivered on the pump by simply telling it how much extra insulin to pump in immediately to cover the amount of carbs being eaten.
The answer to the second question is “It depends who you talk to,” because it seems every pump user is in love with their own pump and believes it is the best. Which says something in itself. So we’ve collected user reviews that cover the basic technical data for some commonly pumps.
Follow the links below to read what users have to say.
Questions, comments about and discussion of pumps and pumping can be found in the Diabetes Support Forum Pumping insulin section.