1.1 Continuous subcutaneous insulin infusion (CSII or insulin pump therapy') is recommended as an option for people with type 1 diabetes provided that: multiple-dose insulin (MDI) therapy (including, where appropriate, the use of insulin glargine) has failed; and those receiving the treatment have the commitment and competence to use the therapy effectively.
1.2 People for whom MDI therapy has failed are considered to be those for whom it has been impossible to maintain a haemoglobin A1c level no greater than 7.5% (or 6.5% in the presence of microalbuminuria or adverse features of the metabolic syndrome) without disabling hypoglycaemia occurring, despite a high level of self care of their diabetes. Disabling hypoglycaemia, for the purposes of this guidance, means the repeated and unpredictable occurrence of hypoglycaemia requiring third-party assistance that results in continuing anxiety about recurrence and is associated with significant adverse effect on quality of life.
1.3 CSII therapy should be initiated 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.
1.4 All individuals beginning CSII therapy should be provided with specific training in its use. Ongoing support from a specialist team should be available, particularly in the period immediately following the initiation of CSII. It is recommended that specialist teams should agree a common core of advice appropriate for CSII users.