Pump Terms

Glossary letters

  1. 4 terms starting with A
  2. 6 terms starting with B
  3. 9 terms starting with C
  4. 6 terms starting with D
  5. 1 terms starting with E
  6. 2 terms starting with F
  7. 2 terms starting with G
  8. 4 terms starting with H
  9. 6 terms starting with I
  10. No terms starting with J
  11. No terms starting with K
  12. 2 terms starting with L
  13. 3 terms starting with M
  14. 2 terms starting with N
  15. 1 terms starting with O
  16. 6 terms starting with P
  17. No terms starting with Q
  18. 1 terms starting with R
  19. 6 terms starting with S
  20. 7 terms starting with T
  21. 1 terms starting with U
  22. No terms starting with V
  23. No terms starting with W
  24. No terms starting with X
  25. No terms starting with Y
  26. No terms starting with Z

Reference

  1. 01A to Z glossary

Explainers

  1. 02How an insulin pump works
  2. 03Pump or injections?
  3. 04Infusion sets and site rotation
  4. 05Carbohydrate counting
  5. 06Alarms and fail-safes
  6. 07Sick days
  7. 08Exercise
  8. 09School and nursery
  9. 10Travelling with a pump

Related reading

  1. 11Diabetes and the nervous system
  2. 12Official UK guidance

About

  1. 13About
  2. 14How we check facts
  3. 15Contact
  4. 16Privacy

Pump or injections? What NICE says

A calm summary of NICE's recommendations on insulin pump therapy and hybrid closed loop systems, written for people trying to understand how the choice is framed in England.

Updated 11 October 20265 min readGeneral information, not medical adviceBy the Pump Terms editors

Outline of a hybrid closed loop A sensor reads glucose and sends readings to a control algorithm. The algorithm adjusts the pump's background insulin. The pump delivers insulin into the body, which changes glucose, which the sensor then reads again. The person still announces meals. Sensor Algorithm Pump Body Glucose Meals are still announced by the person
A hybrid closed loop in outline. The sensor's readings feed an algorithm that adjusts the pump's background insulin; mealtime insulin is still announced by the person.

For most people with type 1 diabetes, insulin is given either by several injections a day or by a pump. The question of which suits whom is decided with a diabetes team, but the starting point in England is guidance from NICE, the National Institute for Health and Care Excellence. This page sets out what that guidance says, in NICE's own terms where the wording matters, and leaves out anything that would amount to personal advice.

What multiple daily injections are

Multiple daily injections (MDI) is the usual alternative to a pump. NICE's guideline on children and young people defines a multiple daily injection basal-bolus regimen as injections of short-acting insulin or a rapid-acting insulin analogue before meals, together with one or more separate daily injections of intermediate-acting or long-acting insulin. In other words, the same two jobs a pump does, background insulin and mealtime insulin, are done by separate injections, often with an insulin pen. How the pump version works is described on how an insulin pump works.

NICE's adult guideline for type 1 diabetes (NG17) recommends multiple daily injection basal-bolus regimens as the insulin injection regimen of choice for all adults with type 1 diabetes. For children and young people, NG18 says to offer a multiple daily injection basal-bolus regimen from diagnosis.

Adults and children aged 12 and over

The main recommendation on pumps comes from NICE technology appraisal TA151, published in 2008. NICE words its first recommendation like this (the guidance itself notes that units for HbA1c have changed from % to mmol/mol since it was published):

Continuous subcutaneous insulin infusion (CSII or 'insulin pump') therapy is recommended as a treatment option for adults and children 12 years and older with type 1 diabetes mellitus provided that either of the following apply: attempts to achieve target haemoglobin A1c (HbA1c) levels with multiple daily injections (MDIs) result in the person experiencing disabling hypoglycaemia; or HbA1c levels have remained high (that is, at 8.5% [69 mmol/mol] or above) on MDI therapy (including, if appropriate, the use of long-acting insulin analogues) despite a high level of care. (NICE TA151, recommendation 1.1; the two criteria are listed separately in the original)

NICE defines disabling hypoglycaemia for this purpose as the repeated and unpredictable occurrence of hypoglycaemia that causes persistent anxiety about recurrence and significantly affects quality of life. The measure used for the second criterion is HbA1c. The same appraisal states that pump therapy is not recommended for people with type 2 diabetes, and that it should only be continued after starting if it brings a sustained improvement in glycaemic control, shown by a fall in HbA1c, or a sustained fall in the rate of hypoglycaemic episodes.

NG17 refers back to this appraisal. It says that insulin pump therapy is recommended as an option in NICE technology appraisal guidance for treating some adults with type 1 diabetes, and points readers to TA151 for the full details.

Children under 12

TA151 treats younger children differently. It recommends CSII as a treatment option for children younger than 12 with type 1 diabetes provided that MDI therapy is considered to be impractical or inappropriate, and that children on pumps would be expected to undergo a trial of MDI between the ages of 12 and 18. NG18 echoes the first part: if multiple daily injections are not appropriate for a particular child or young person, it says to consider an insulin pump, as recommended in TA151. NG18 also says that when children and young people start on a pump, they and their families or carers should be trained to use it, and that a specialist team should provide ongoing support.

Specialist teams and structured education

TA151 recommends that CSII be started only by a trained specialist team, which should normally comprise a physician with a specialist interest in insulin pump therapy, a diabetes specialist nurse and a dietitian. It adds that such teams should provide structured education programmes and advice on diet, lifestyle and exercise.

Structured education means a taught course with a written curriculum and trained educators, rather than ad hoc advice. NG17 recommends offering all adults with type 1 diabetes a structured education programme of proven benefit, giving the DAFNE (dose adjustment for normal eating) programme as an example. More about how that fits with pumps is on the page about carbohydrate counting and boluses.

Hybrid closed loop in NICE TA943

A separate NICE appraisal, TA943, published in December 2023, covers hybrid closed loop systems. In summary, it recommends them as an option for:

  • adults with type 1 diabetes who have an HbA1c of 58 mmol/mol (7.5%) or more, or have disabling hypoglycaemia, despite best possible management with at least one of CSII, real-time continuous glucose monitoring or intermittently scanned continuous glucose monitoring;
  • children and young people with type 1 diabetes;
  • women, trans men and non-binary people with type 1 diabetes who are pregnant or planning to become pregnant.

NICE says these systems are recommended only if procured at a cost-effective price agreed by the companies and NHS England, and used with the support of a trained multidisciplinary team experienced in CSII and continuous glucose monitoring. The person or their carer must be able to use them and be offered approved structured education, or be competent in insulin dosing and adjustments. NICE also states that access is through a five-year phased roll out in line with NHS England's implementation plan.

Who decides, and why access varies

NICE sets out who should be considered. The decision itself is made between a person (or their family) and their diabetes team. Diabetes UK states that pumps are generally only offered on the NHS to some children and adults with type 1 diabetes, and that people who do not qualify may be able to self-fund or, in some circumstances, submit an Individual Funding Request through their team. The NHS adds that hybrid closed loop systems are being made available gradually. The editors cannot give an area-by-area picture, so the diabetes team is the best guide to what is offered locally.

Questions people ask

Does NICE say everyone with type 1 diabetes should have a pump?

No. TA151 recommends pump therapy as a treatment option when particular criteria apply, and NG17 and NG18 describe multiple daily injections as the usual starting regimen. Each decision is made with the diabetes team.

Are the TA151 criteria the only route to a pump?

They are the criteria NICE sets out for pump therapy. The NHS also describes who may be offered a pump and who may be offered a hybrid closed loop system, and the team can explain how those apply to a particular person.

In short

NICE treats multiple daily injections as the usual regimen and recommends pump therapy as an option when set criteria apply, with different wording for under 12s and for those aged 12 and over. Hybrid closed loop systems are covered by a separate appraisal and a phased roll out. Whether a pump or a loop is right for any one person is a matter for that person and their diabetes team.