Should I get a pump?

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Tiss

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Type 1
I’m 67 years old and have had Diabetes for 40 years. I’m toying with the idea of getting a pump because of all the great reviews from people. Since getting a Libre CGM my Hba1c is now 7.2 and still coming down. From a conversation with Cumbria Endocrinologist in 2019 I would not be funded for Libre if I got a pump. Any advice would be welcomed. Thank you.
 
Hi @Tiss My default answer is always Yes! Pumps give more flexibility and allow your basal to match your needs much more closely.

I don’t understand why you would lose your Libre funding. I know many pump users who have a Libre, and was offered one myself (but declined).
 
Is there any reason why Libre would stop being funded if you got a pump? I Love my pump, it gives me the tools to micro manage my diabetes.
 
There are criteria for the NHS funding a Libre - eg to try to prevent disabling hypos or reduce their HbA1c. Each person getting one, agrees to their usage being reviewed in 6 months time to see if they have gained anything from having it. I had to sign and date the agreement.

I have used a pump for 10 years and due for another new one soon!
 
It is a big change and not for everyone.

However I would never want to return to injections now. There is a lot of work at the start to get the basal rates to match your individual needs, but your team will support you in sorting this out and teach you how to test and adjust these. Once it is sorted it makes life so much more flexible and you can
  • deliver Bolus in much smaller increments so be a lot more accurate.
  • Deliver your Bolus in a variety of ways to match the foods you have eaten. If I eat a high fat meal I deliver my insulin over an hour rather than all at once. If I have a bigger meal I split my insulin and have a good chunk to start with then the rest over the next 30 min, ...
  • Turn your basal insulin up or down as necessary and see a response within an hour. I like being able to be more spontaneous. If invited to go off for a walk I just turn my pump down and delay the start of the walk for an hour and then that is sorted. On MDI the basal insulin is already in and I would have had to load carbs.
  • Using the pump alongside the Libre I can make more use of the Libre info as I am more able to adjust things in response to the data.
I could continue, but I think you get the gist. I Love my pump.

There are lots of different options with tubed or patch pumps. Bluetooth or access needed to the pump. ...
 
I have just reread your post and seen the issue around Libre not being offered if you switch to a pump. As @trophywench has said it is worth checking the criteria for both the pump and Libre in your region, although the Libre criteria are now national ones.

Initially I self funded the Libre, but now have both in NHS. When I switch to using sensors that ‘talk to my pump’ I will be self funding again. However it seems a good way of spending a pension to make life so much easier.
 
Do you see a hospital diabetes clinic for your D care, or what/where?
 
That info doesn't tell me anything grovesey. At one time I used to have conversations with endos from all sorts of places - not all of them specialised in diabetes and even if they were from Warwickshire where I live there at least 3 CCGs and shedloads of different hospital trusts and different ways of organising healthcare for the residents. Cumbria is a huge area.
 
There is no reason why you cannot have both pump and Libre on the NHS if you meet the relevant national criteria.

There should not be any kind of postcode lottery (though in reality it is clear that unfortunately this exists).

NICE TA 151 for insulin pumps (see https://jdrf.org.uk/information-sup...therapy/can-i-get-an-insulin-pump-on-the-nhs/)

and Mandatory NHS England Libre criteria

NHS England » Flash Glucose Monitoring: National arrangements for funding of relevant diabetes patients

Health and high quality care for all, now and for future generations
www.england.nhs.uk www.england.nhs.uk

I would also prefer to keep using an insulin pump for as long as ine is available to me (and keeps working well for my diabetes management). I find an insulin pump to be more precise, more flexible, and a much more subtle and tweakable way of using insulin.

I have lost almost all of my hypoglycaemia while keeping also reducing my HbA1c.

The do take work, and a bit of attention to detail, but they are worth the effort in my opinion.
 
Inka said:
Hi @Tiss My default answer is always Yes! Pumps give more flexibility and allow your basal to match your needs much more closely.

I don’t understand why you would lose your Libre funding. I know many pump users who have a Libre, and was offered one myself (but declined).
Click to expand...
My endocrinologist told me that Northumbria CCG , sorry I forgot that Cumbria and Northumbria have joined, didn’t fund Libre with a pump, but it was Feb 2019. So that put me off the idea.
 
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That was 18 months ago, it might be worth looking at your CCG website to see what they fund. What hospital are you seen at?
 
trophywench said:
That info doesn't tell me anything grovesey. At one time I used to have conversations with endos from all sorts of places - not all of them specialised in diabetes and even if they were from Warwickshire where I live there at least 3 CCGs and shedloads of different hospital trusts and different ways of organising healthcare for the residents. Cumbria is a huge area.
Click to expand...
Sorry, our Health Authority is now Northumbria. The 2 joined.
I think I will contact my DN and ask what the criteria is now for my area.
 
SB2015 said:
It is a big change and not for everyone.

However I would never want to return to injections now. There is a lot of work at the start to get the basal rates to match your individual needs, but your team will support you in sorting this out and teach you how to test and adjust these. Once it is sorted it makes life so much more flexible and you can
  • deliver Bolus in much smaller increments so be a lot more accurate.
  • Deliver your Bolus in a variety of ways to match the foods you have eaten. If I eat a high fat meal I deliver my insulin over an hour rather than all at once. If I have a bigger meal I split my insulin and have a good chunk to start with then the rest over the next 30 min, ...
  • Turn your basal insulin up or down as necessary and see a response within an hour. I like being able to be more spontaneous. If invited to go off for a walk I just turn my pump down and delay the start of the walk for an hour and then that is sorted. On MDI the basal insulin is already in and I would have had to load carbs.
  • Using the pump alongside the Libre I can make more use of the Libre info as I am more able to adjust things in response to the data.
I could continue, but I think you get the gist. I Love my pump.

There are lots of different options with tubed or patch pumps. Bluetooth or access needed to the pump. ...
Click to expand...
That’s very helpful information. Thank you.
 
Don't ask that Tiss - as has already been said, the criteria cannot differ, they are NHS criteria centrally, not decided by individual areas.

Instead, say you wondered if you ought to start looking at getting a pump and you'd welcome discussing this with them - ball in their court!
 
Tiss said:
sorry I forgot that Cumbria and Northumbria have joined, didn’t fund Libre with a pump, but it was Feb 2019. So that put me off the idea.
Click to expand...

Ah! that might explain things. The nationwide mandatory Libre guidance launched in March 2019, so what you were told was part of the dreadful postcode lottery which the new guidance was designed to tackle
 
Tiss said:
My endocrinologist told me that Northumbria CCG , sorry I forgot that Cumbria and Northumbria have joined, didn’t fund Libre with a pump, but it was Feb 2019. So that put me off the idea.
Click to expand...

Ah, ok. Well for me if it was a choice between a pump and a Libre, the pump would win hands down. It’s a potential life-changer. I felt so much better within a few days of having mine, even though I thought I felt fine before. Obviously it’s great being able to have fractions of units for boluses and correction doses, but the real benefit is the basal.

Of course, not having to inject is great too (just change the cannula every 3 days) but for me the basal is probably my top thing.
 
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