INPUT

Introduction to INPUT

Since the release of the first NICE guidance on insulin pump therapy (TA 57) in 2003, interest in insulin pumps and the better health that they can offer to motivated people with insulin-requiring diabetes has expanded in the UK. In the past five years, the number of pump users in the UK has grown from about 2000 to almost 8000 in 2008, and the numbers continue to increase each year.

Insulin

The word "insulin" comes before the word "pump" so let's start there. In people with diabetes, insulin treatment (therapy) has three purposes:

First. Insulin must meet the background, or basal, insulin requirements of the body. In a person without insulin-requiring diabetes, the pancreas releases a small amount of insulin constantly, almost like a dripping tap. Basal insulin controls the release of stored glucose from your liver. It also regulates release of free fatty acids by the liver and fat cells. Furthermore, insulin balances other hormones found in the blood and transports amino acids into cells. Insulin may do even more things that haven"t been discovered yet. In people with insulin requiring diabetes, basal insulin is usually replaced by one or two injections of long-acting insulin every day.

Second. Insulin must be used to control blood glucose (sugar) levels around meals. In a person without insulin-requiring diabetes, the pancreas releases a bolus of insulin to help the body process energy from food and drink. When you have eaten, your digestive tract senses the food. In order to get energy out of the food (metabolize it) the body must release several hormones. Insulin is one of these hormones. Its role is to help the body save some energy for later, for instance between meals or overnight. In people with insulin requiring diabetes, this bolus is usually replaced by a mealtime injection of rapid-acting insulin.

Third. When the blood glucose level goes up above a normal level, insulin lowers it to a normal range. In people with and without diabetes, insulin works in two ways to reduce the amount of glucose in the blood. First, it acts on the liver to reduce the amount of glucose being released by the liver into the blood. Second, it helps cells within the body use the glucose for energy. When the body"s cells take up glucose from the blood and use it for energy, the amount of sugar in the blood goes down.

Healthcare professionals agree that the best way to manage insulin-requiring diabetes is to imitate how the non-diabetic body regulates glucose levels. Depending on their own body"s needs, some people use two insulin injections a day, others three or four, and others even more. Some people use an insulin pump instead. The goals of insulin therapy are the same whether someone takes injections or uses a pump: 1) provide enough basal insulin; 2) cover glucose levels around meals; 3) reduce glucose levels to a healthier, normal range when they go too high.

This article gives brief answers to five common questions about insulin pump therapy:

What is an insulin pump and what does it do?
How can an insulin pump improve life with insulin-treated diabetes?
Who is most likely to benefit from using a pump?
Is insulin pump therapy available within the NHS?
How do you obtain a pump?