There have been loads of stats mentioned about the use of insulin pumps in the UK versus the rest of the world, with the most telling being the comparison between the UK and the US, where something like 40% of adults are using an insulin pump, compared to around 12% in the UK. This leads me on to my hypothesis about pump use in the UK.
As we all know, the majority of the UK T1 population is not offered Continuous Subcutaneous Insulin Infusion therapy, due to the NICE guidelines, and additionally, the cost. if you want it, unless you are suffering very high Hba1C levels, you have to fight in most cases.
My hypothesis is that this leads to a level of mystification of the use of pumps and the uptake of pumps by individuals, and I don’t think this is helped by the terminology often used in association with pumps.
What do I mean? Well let’s take a quick look at the terminology I am referring to. The pump as a “proactive tool” in treating T1D. A proactive tool. Let’s think about the use of Proactive. It depicts, to my mind, something that, ahead of you doing something, can predict and adjust in order to deal with it. Proactive suggests that it doesn’t need any inputs. That’s an artificial pancreas to me, and I wouldn’t say that many pumps (aside from maybe SmartGuard on the 640G) are truly proactive…
Then there’s the process of getting one. It seems long and drawn out, as much as a result of funding restrictions as anything. This plays a large part in how you get assessed and then actually get the pump. They are expensive and if you find you don’t really like it, an expensive mistake. As a result there is a significant build up to getting one, as much to assess your reaction to attachment and likelihood of being able to use it as anything else. As a result of the sparsity, I sometimes think they’ve gained a status of being capable of making life normal, and this just isn’t true.
A pump is work. How hard probably depends on both you and your diabetes, and will always be a very individual journey. For many they do indeed make life much easier, and for some they just don’t work.
But they aren’t a mystical solution to living with T1D. They provide the current best way to matchh background glucose production with insulin needs, and in my opinion should be readily available to anyone who feels that they could use it effectively. Not just those who struggle with Hba1C levels and probably need a whole other intervention.
As long as insulin pumps remain something that the few have, I postulate they will retain their mystical status in the UK, because they simply aren’t that common. I suspect that in countries with a higher incidence, they are considered much more part of T1D life. I’d like to be proved wrong about it, but with the model we have in the UK currently, I’m not too sure about that!