The new HSE Insulin Pump and Continuous Glucose Monitor CGM Contract has NOT been officially announced yet even though companies submitted their tender applications a mere 18 months ago, November 2017. The contract is also already dated as two of the pump companies have launched brand new insulin pump models in 2018.
This post is divided into three sections:
What is an insulin pump and how do they work
Insulin Pumps available in Ireland
HSE Qualifying Criteria for Insulin Pump Therapy
It's worth remembering though that an insulin pump is not for everyone. It has to be the right device, at the right time, for the right person. Always remember that everybody's diabetes is different and what works for you may not work for someone else!
What is an Insulin Pump?
Feel free to skip this bit if you already know
An insulin pump is a box-like device that delivers insulin through a tiny flexible cannula/plastic needle under your skin. It’s programmed to deliver insulin at different rates during the day (almost like a portable mini IV drip that they have in hospitals) with larger doses given by the wearer for meals.
Your insulin pump will act as your pancreas and you have to wear it 24/7, so it is important to find one that works for you. Each device comes with different features and different software packages that you will have to upload your information to before you attend your clinic.
It is also worth remembering that an insulin pump does not work for everyone!
Diabetes UK have a very useful section on their website which will give you more detail about how insulin pumps work
https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/insulin-pumps
And if you are wondering what the advantages and disadvantages are of using an insulin pump the Joslin Diabetes Centre has this great webpage.
There are three insulin pumps available in Ireland at the moment through the HSE if you meet qualifying criteria. See more about the qualifying criteria below.
INSULIN PUMPS AVAILABLE THROUGH THE HSE IN IRELAND
Updated May 2019
Accu-Chek Combo by Roche
The Accu-Chek Combo insulin pump has been around for a number of years and is called the Combo System because the system combines an insulin pump with a smart handset that is both a blood test meter and a bolus calculator.
Previously available in Ireland
Key features
Combines an insulin pump with a smart handset that is both a blood test meter and a bolus calculator
Colour screen handset doubles as blood glucose meter
The handset offers extra discretion so you can operate the pump without no-one needing to know you are wearing one.
Includes a built-in bolus calculator which offers suggestions how much insulin should be in your bolus
Large 315 unit reservoir
Bluetooth integration between the handset/meter and the pump, so you don’t have to manually entering your test result before using the bolus calculator
Not directly integrated with a CGM system in Ireland
Technical Specifications
Basal rate increments: 0.05 to 50 units per hour
Basal profiles: Up to 5
Basal rates per profile: 1 to 24
Bolus doses: 0.1 to 50 units. 4 bolus options: quick/standard/extended, bolus/multiwave
Water protection: IPX 8 - Protected against effects of temporary immersion in water for 60 minutes at up to 2.5m depth
I was unable to find reviews of the Accu-Chek Combo from PWDs
MiniMed 640G by Medtronic
This pump has been available in Ireland for at least a year and currently it’s the only pump available that is a sensor augmented pump (SAP) meaning the Continuous Glucose Monitoring (CGM) capability is combined into the pump system. It can be used as a pump only or as a pump/CGM combo. See this webpage for more information on cgms.
This pump has been available in Ireland for at least 18 months
It’s the only pump on the contract that includes Continuous Glucose Monitoring (CGM) capability
Available as a pump only or as a pump/CGM combo
Key features - Pump Only
Integrated with Contour NEXT Link blood glucose meter (wirelessly connects to your pump, allowing you to send BG meter readings to your pump)
Colour screen –with light adjusting display
Designed for easy use by both left-handed and right-handed people
Includes a built-in bolus calculator which offers suggestions how much insulin should be in your bolus
Downloads to CareLink™
Technical Specifications
Basal profiles: 8 basal patterns
Available with either a 180 unit reservoir or a 300 unit reservoir.
Basal rate increments: 0.1 units, 0.05 units, or 0.025 units
Additional Features if CGM is included
Integrated with Enlite II CGM sensors and has SmartGuard Technology
SmartGuard - can predict and prevent most hypos
SmartGuard® can predict when approaching low glucose levels 30 minutes in advance and automatically stop insulin delivery.
When blood glucose levels recover, SmartGuard automatically resumes basal insulin delivery
Reviews from PWDs chosen at random
Mike at Everyday ups and downs
Tim from DiabetTech
Dave from the Tangerine Diabetic
YpsoPump by Ypsomed
The YpsoPump is not very well known but it has a compact design and is brand new to Ireland. Those who attended Thriveabetes 2018 would have been able to see it up close.
Key features
Small insulin pump with a touchscreen
Pre-filled insulin cartridges – for a quick and convenient cartridge change from NovoNordisk or Self-filled mylife YpsoPump Reservoir – for the insulin of choice
mylife App – comprehensive data at your fingertips
mylife Software – Bluetooth sync between pump, MyLife Unio BG meter and Smartphone App Links to mylife App for bolus calculations and data sharing / review
Technical Specifications
Basal profiles: 2 Basal profiles
Basal rate increments: Minimum 0.02U/h in increments of 0.01U/h Maximum: 40U/hr;Up to 24 segments per programme. Temp basal available – 15 minute increments for up 24hr
160 unit reservoir
Bolus Increments: 0.1U, 0.5U, 1.0U and 2.0U
Reviews from PWDs chosen at random
Jen from Miss Jen Grieves
Ashley from Bitter Sweet Diagnosis
Frank from Type1 Writes
INSULIN PUMP QUALIFYING CRITERIA
FOR ADULTS WITH TYPE 1 DIABETES
The National Clinical Guidelines for Adults with type 1 diabetes states on page 51, that “For guidance on the use of continuous subcutaneous insulin infusion (CSII or insulin pump) therapy for adults with type 1 diabetes, see Continuous subcutaneous insulin infusion for the treatment of diabetes mellitus (NICE technology appraisal guidance 151).”
The NICE UK guidelines recommend Insulin Pump Therapy for adults and children 12 years and older with type 1 diabetes if:
You cannot achieve your HbA1c target using multiple daily injections (MDIs)
You experience disabling hypoglycaemia. “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.
HbA1c levels have remained high (that is, at 8.5% or above) on MDI therapy (including, if appropriate, the use of long acting insulin analogues) despite a high level of care.
However, you may meet the qualifying criteria for an insulin pump but if your diabetes clinic does not have an insulin pump programme for adults, and many do not, you will not be able to get one. The clinic can’t offer you an insulin pump if they do not have.the specialist staff or funding to support an insulin pump programme.
In this situation you may need to transfer your care to a diabetes clinic that does have an insulin pump programme or be referred to a private hospital who offers the Programme. Online support groups are an excellent way to find out what clinics offer insulin pump therapy is to join one of the many private Facebook Groups found here and connect with people already “pumping”.
FOR CHILDREN WITH TYPE 1 DIABETES
It is standard practice that all children under the age of 12 years are offered an insulin pump as per the 2015 Model of Care for All Children and Young People with Type 1 Diabetes and the National Institute for Health and Clinical Excellence (NICE) Guidelines (2008)
The centres providing insulin pump therapy are:
Children’s University Hospital, Temple Street (Dublin)
Cork University Hospital (Cork)
National Children’s Hospital, Tallaght (Dublin)
Our Lady of Lourdes Hospital, Drogheda
Our Lady’s Children’s Hospital Crumlin (Dublin)
Sligo Regional Hospital (Sligo)
University Hospital Limerick (Limerick)
University Hospital Galway (Galway)
These units receive referrals from the surrounding areas. Additionally Sligo provides an outreach service to Letterkenny General Hospital.