# Eligibility for pumps



## Kelz7683 (Aug 15, 2021)

Hi all, I was wondering if you could explain the eligibility to me regarding pumps on the Nhs my Hba1c was 148 and it’s now 122. I know this is extremely high I’m newly diagnosed and awaiting my first appointment at the diabetes clinic so I was wondering if it’s worth asking about the pumps or not? Also do you prefer pumps or is injecting easier? I’m currently on novorapid 4 times a day and toujeo once a day and I’m always struggling to remember to inject before dinner time. Thankyou for any help you can give.


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## Inka (Aug 15, 2021)

Hi @Kelz7683  Looking back it seems you were only diagnosed end of May/early June this year? It’s still very early days for you so I wouldn’t think you’d get a pump yet. People have to show they’ve tried other methods and that they have the knowledge to use a pump. Your HbA1C will naturally take a while to drop and it’s safer to bring your blood sugar down slowly anyway.

Here’s an idea of the criteria:


_Continuous subcutaneous insulin infusion or ‘insulin pump’ therapy is recommended as a possible treatment for adults and children
12 years and over with type 1 diabetes mellitus if:
• attempts to reach target HbA1C levels with multiple daily injections result in the person having ‘disabling hypoglycaemia’, or
• HbA1c levels have remained high )with multiple daily injections (including using long-acting insulin analogues if appropriate) despite the person and/or their carer carefully trying to manage their diabetes._

Are you carb counting and adjusting your mealtime insulin? Are you pre-bolusing at the correct times for you? Can you give us an idea of when you’re going high and how high you’re going? If you tell us a little more, you’ll get some more tailored suggestions that might help you.


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## helli (Aug 15, 2021)

It is always worth asking but I would ask yourself why you want a pump. It brings better management but it requires more effort.
The value in pumps comes from two areas
- the ability for small doses. My pump can give me doses of 0.05units. This gives me finer control because I am sensitive to insulin.
- the ability to alter basal doses throughout the day. This is beneficial if you experience major dawn phenomenon or you struggle with hypos when exercising.

This doesn't come easy though. As well as the frustrations when first setting up a pump (what is your basal pattern?), you need to be more accurate with carb counting, need dexterity to change pump sets and, most importantly, need to be able to quickly revert to injecting: pumps rarely fail but they do and you need to be able to switch back to injecting at a time when you are probably stressed and have no background insulin on board.

Many ccgs insist you have been on a recent carb counting course to be able prove you are up to the job.

I believe you are more likely to get a Libre than a pump. A pump does not automatically bring your levels down. It is not a silver bullet.


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## Pattidevans (Aug 15, 2021)

Kelz7683 said:


> Hi all, I was wondering if you could explain the eligibility to me regarding pumps on the Nhs my Hba1c was 148 and it’s now 122. I know this is extremely high I’m newly diagnosed and awaiting my first appointment at the diabetes clinic so I was wondering if it’s worth asking about the pumps or not? Also do you prefer pumps or is injecting easier? I’m currently on novorapid 4 times a day and toujeo once a day and I’m always struggling to remember to inject before dinner time. Thankyou for any help you can give.


Hi @Kelz7683 A pump will not “do the work for you”.  In other words you will still have to remember to bolus (give yourself an insulin dose) before meals.  Its a very steep learning curve and it’s better if you have a good understanding of the whole mechanism of insulin/basal needs/food effects before going onto one.  That's not to say you wouldn’t benefit from one further down the line.  

As @Inka says, it’s better to bring your levels down slowly to begin with.  During which time you’ll no doubt learn a lot about your own bodily needs which will equip you to take on a pump at a later stage.   A good book to help with this is “Think like a Pancreas” by Gary Scheiner.


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## Kelz7683 (Aug 18, 2021)

Thankyou everyone. By the sounds of it I’m best just sticking to the injections instead of considering a lump or libre. If it would benefit me I would have purchased one even if I wasn’t eligible on the Nhs.  Yes I was diagnosed end of may/beginning of June.  I’m still learning about carb counting and changing things to help keep my blood sugar levels correct. I take novorapid 4 times a day of eating and toujeo once a day at dinner time so usually about 6pm. 
As I am still so new to all of this that’s why I thought I would ask for your help and advice as there is so much to learn and adjust to try and live with it. My blood sugar levels seem to go high around 3-4pm and it ranges between 14-18 but it’s not every day. I haven’t increased/decreased my insulin for a while now as I haven’t spoke to anyone which I’m assuming is because my appointment is soon.
Thankyou everyone. Kel.


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## SB2015 (Aug 18, 2021)

Hi @Kelz7683 

It sounds like you are getting your head round things but by bit. There is a lot to learn at the start and it takes a bit of getting used to.  As @Inka has said a Libre is a good addition to your tools and these are available on the NHS, so if you were offered that I would take it.  It gives you sight of what your levels are in between meals, whereas the finger pricks are the spot tests done before meals and tell you nothing of what has gone on in between.  Managing a pump will depend on all that you are learning now and could be something to look at in the future.

You mention that you go high in the afternoons.  How long after lunch is this?  I ask because it could be that the insulin dose for your lunches on those days needs adjusting.  Some of us find that we need different ratios at different times of the day.  Also it could be related to what you eat for lunch.  Perhaps make a note of the amount of carbs/what you ate and BG levels before and 2 hours after lunch and see if there are any pattern.  Foods higher in fat will slow the release of carbs so this can make you drop and then rise after the meal, later than you would expect.  Pizza does this for me in spectacular style!!!!

As you have an appointment soon it will be worth gathering a list of questions to discuss.
There is loads to learn but it does get a lot easier.  Keep the questions coming And tap into the practical experience on here.


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## Pattidevans (Aug 18, 2021)

Hi @Kelz7683

Don’t be discouraged, you do seem to be getting your head round it all.  As @SB2015 and @helli both say, you would certainly benefit from a Libre.  So do ask about that and if it’s not available in your area and you can afford it then it’s worth buying (though don't forget they only last 2 weeks)  - or actually Abbott are offering a 2 week free trial right now see www.freestylelibre.co.uk  which is worth taking advantage of.  Also you would doubtless benefit from doing their online learning as to how to use the sensor alerts.  See this link.

Regarding the afternoon highs, are you bolussing right before you eat?


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