What to do if you want a pump
Getting a pump in Scotland is not always as simple as it should be. It is still very much a postcode prescribing lottery meaning getting a pump may be dependent on where you live. More and more clinics in England and round the world are offering pumps as a first course of treatment particularly for pre-school age children (due to precise dosing) however it is still unusual for people to be offered a pump in many areas of Scotland even when they meet criteria. If you are looking for a pump in England please visit INPUT
It is more usual for a patient to approach their team to enquire about pump therapy. In many cases you will be fobbed off with excuses, e.g. you are already on an intensive regime (MDI) so a pump will be of no greater benefit, a pump would not suit your lifestyle, a pump is no good for needle phobics, we are unable to provide training, there are more needy people than you, we don’t have funding for pumps, you don’t meet guidelines, you are too old, you are too young, you don’t have the intelligence to use a pump, you are too well controlled, you don’t have good enough control – to name but a few of the excuses reported to us!
Unlike England and Wales who follow NICE mandatory TA’s (Technology Appraisal) Scotland’s Health Boards do not have clear guidance they must follow. Each board may have their own guidance, but it is just guidance and not mandatory.
Scotland have publicly committed to NICE TA 151, but only some boards clearly follow this guidance while others may just consider it and others not follow it at all. SIGN Guidelines are also used in Scotland, read CSII p33 of SIGN 116.
In 2012, after a long campaign by several interested individuals and groups, The Scottish Government released a statement regarding the future provision of insulin pumps.
On 27th Feb 2012 the Government reaffirmed their position on pumps by releasing a statement of targets they have set out for Scotland. We were very pleased to see the targets, however some concerns came to light, read Diabetes UK Scotland’s letter to the Petitions Committee for more information.
A letter was sent to each Health Board Chief Executives (CEL 2012 04) with full details of targets and what is expected of each board. We were pleased at the targets as a starting point, which states that by March 2015, Scottish NHS Boards will almost triple the number of pumps available to people of all ages with type 1 diabetes to more than 2000 (inc. 25% of young people under the age of 18 using an insulin pump) We hoped to see pump provision continue to increase significantly in Scotland – unfortunately this has not proved to be the case.
On 29th March 2012 Humza Yousaf, SNP Glasgow received a response to his PQ, which again reaffirmed the government’s commitment to pumps at this time.
Since the completion of the 3-5 year strategy to meet targets set by the government many areas have reverted to minimal pump provision, and in some areas allocating less funding than before 2012.
If you are still struggling to get a pump, please keep us updated, by emailing us at info@iPAGScotland.org or joining us on Facebook
- Read our benefits and disadvantages of Insulin Pump Therapy which will help you determine if a pump could be for you.
- Can you carb count and adjust insulin to match food, exercise, illness etc?
- Are you willing to do frequent finger prick tests and keep records?
- Are you willing to keep in close contact with your health care professionals?
- Read the NICE Guidelines, do you meet the criteria?
For adults if you continue to have a HbA1c greater than 8.5% despite your best efforts on MDI or if you suffer from disabling hypoglycaemia you may be eligible for a pump. (For the purpose of this guidance, disabling hypoglycaemia is defined as the repeated and unpredictable occurrence of hypoglycaemia that results in persistent anxiety about recurrence and is associated with a significant adverse effect on quality of life)
Children under 12 years old are eligible when MDI is inappropriate or impractical
- Do your homework – join forums and support groups to hear personal experiences of pump therapy, Read INPUT and Insulin Pumpers websites. A good group for parents of children with diabetes is the UK CWD Facebook Group for information and support. Or join us on Facebook, we have two groups, a pump group and a general Group – Type 1 Diabetes in Scotland.
A pump is not a magic cure, however the vast majority of people will find a good improvement in their control over MDI if they have the motivation and commitment to make the pump work for them.
If you feel you would like to go ahead with a trial of insulin pump therapy the next step is to approach your care team.
To help us get a clear picture of what is happening all over Scotland please join us on Facebook.
The 2016 SNP manifesto included this:
Text found SNP Manifesto 2016 page 5
We hoped for a bigger commitment and one which included CGM, however we await the details of this and will continue to campaign for equal access to pumps and technology no matter where you live.