Starting on an Insulin Pump

How do pumps work?

Insulin pumps are used for patients with type 1 diabetes who have difficulty managing their diabetes effectively by multiple daily injections. The pump can mimic more closely the action of the pancreas than injection therapy and can give more flexibility to the user.

Pumps use fast acting insulin only. This is delivered constantly over the 24 hour period. The rate is programmed by the patient to suit their needs (Basal). This acts instead of long acting background insulin. Insulin is then delivered for food according to the carbohydrate content of meals and snacks (Bolus). The pump is attached to the person via a cannula and plastic infusion tube (Infusion set) for 24 hours a day. Control of insulin delivery is done by pressing pump controls rather than giving separate injections. The cannula is changed every 2-3 days.

At Bournemouth we have a well-established pump service and one of the largest groups of patients in the UK on pump therapy. In order that patients benefit from using a pump, they have to undergo assessment and their needs meet the NICE criteria.

Assessment

Do you have problems with regular hypoglycaemia (hypos), which affect your daily lifestyle?

Are you finding it difficult to improve your blood glucose levels without having hypos?

Do you have problems with insulin absorption or your injection sites?

Are you able to perform at least 4 finger prick blood tests a day?

Have you attended an education programme such as BERTIE and are confident about counting carbohydrate and adjusting insulin for food, exercise, illness, etc?

It is important that you have had the opportunity to go through an education programme before starting a pump so that you are confident about your daily diabetes management skills and will benefit from the other advantages of a pump. We can offer this but the process can take a few months to complete.

Further information about our education programme BERTIE is available.

Phone 01202 704929.

Additional information and practice on carbohydrate counting and insulin adjustments is on our web site www.bertieonline.org.uk. It is also important that you are shown the pump available and understand the key issues around managing diabetes on a pump.

Funding

For pump therapy, it is necessary for your local CCG to agree to the funding. A written referral from your GP or hospital consultant is required if no prior agreement is set with Bournemouth Hospital Trust.

Here is a leaflet about the insulin pump training programme.

Pump Start Programme

Once the hospital team and you are confident that you can benefit from pump therapy and you have undergone necessary education, a date can be set for your pump start. You will be given provisional dates for the next pump starts and these will be confirmed 1-2 months beforehand.

About the pump start programme

The programme lasts in total for a year and consists of 3 half days pump start training and follow-up education sessions at 1, 3, 6 and 9 months later. You will then be seen in the consultants' pump clinic. Training is usually done with groups of 4 patients.

Day 1

Introduction (Monday or Tuesday 9.00 - 12.00)

Learn about principles of pump therapy, dose calculations and set your goals. Practise using features of your pump and handset and choose infusion set over the next week.

Day 2

Get started (Following Monday 9.00 - 12.00)

Get connected. Fill insulin cartridges. Start/stop the pump. Using bolus advisor. How to treat hypoglycaemia and manage illness.

Setting temporary basal rates. Plan for day 1 at home.

Day 3

Review progress (Tuesday or Wed 9.00 - 11.30)

Review of your first day. Test basal rates. Taking charge of your pump therapy.

Contacts and supplies.

Training takes place at the Diabetes Centre education room and is lead by a pump educator, either nurse or dietitian. Often a occasionally a representative from the pump company is also present. Follow-up education sessions are held on a Wednesday in the same education room on Wednesday afternoons and will last for 1-2 hours.

In between the pump start visits you will continue your other diabetes commitments as usual for example eye screens, clinic visits etc.

The courses take place in the diabetes centre education room and are led by an diabetes team pump expert, usually a pump nurse or dietitian. There may also be support from the company who provides the pump for technical questions.

Please contact us for more information.