Patient Selection

The following is very important:

Insulin pump therapy should not be considered as “an easy way out” for patients who are non-adherent to their treatment regimens, who do not wish to perform self-blood glucose monitoring, or who are seeking an “easy” alternative to multiple injections. 

Rather, CSII should be reserved for those patients who are concerned about their glycaemic control, who are extremely motivated and meticulous with their self-care, and who despite this, fulfil the criteria outlined below. 

The healthcare provider should not automatically consider or prescribe CSII because a patient or parent requests it, or because glucose control is not optimal. Pump therapy should be primarily reserved for patients with specific problems which may include the wish to achieve the quality-of life benefits of insulin pump therapy. 

Patients should be under the management of a specialist care team, as outlined in the previous section.

Patients who may be considered for insulin infusion pump therapy

Before patients can be considered for CSII therapy they must:

• Have demonstrated knowledge of and adherence to MDIs with appropriate dose adjustments
• Have demonstrated the willingness to perform home blood glucose monitoring at least four times daily, and preferably six times a day
• Have shown, to the satisfaction of the healthcare team, that they do not regularly miss injections or abuse their meal plan, and are willing to work with the multidisciplinary team
• Have been instructed on carbohydrate counting by a qualified dietitian
• Be motivated to succeed and have realistic expectations
• Ideally, patients should be required to enter into a contract with the pump centre for pre-pump appraisal, education and ongoing management. Explicit in this contract will be indications for insulin pump therapy, pre-determined follow-up with the insulin pump team, and a definition of treatment targets to be maintained
• Have none of the contraindications outlined below

Patients and/or family members must:

• Understand the factors influencing blood glucose levels and have the ability to vary and plan bolus doses based on tested blood glucose levels, planned carbohydrate consumption during the next meal, and planned physical exercise
• Feel comfortable with the pump and have the ability to operate it
• Preferably, have a family support system, as well as the support of a healthcare team who is knowledgeable in pump use and who is available 24 hours a day
• Have experience in intensive therapy with multiple injections
• Be willing to sign a contract agreeing on patient specific outcome goals and minimum required annual follow-up visits
• Undergo an appropriate training and education programme in pump use

Children must have access to an adult during school hours in case of pump problems, and the ability to programme the bolus dose at school.