3 The technology
3.1 The following insulin pump models are currently available: Animas 2020 (Animas, Johnson & Johnson, cost £2600), Paradigm real-Time mmT-522 (Medtronic, cost £2750), Paradigm real-Time mmT-722 (Medtronic, cost £2750), Accu-Chek Spirit (Roche Diagnostics, cost £2375), Accu-Chek D-Tron Plus (Roche Diagnostics, cost £996) and Deltec Cozmo (Smiths Medical, cost £2750).
3.2 Continuous subcutaneous insulin infusion (CSII) therapy makes use of an external pump that delivers insulin continuously from a refillable storage reservoir by means of a subcutaneously placed cannula. The pump can be programmed to deliver a basal rate of insulin throughout the day, with higher infusion rates triggered by the push of a button at meal times. This may be a bolus or over a period of time, and it can also deliver different basal rates of insulin at different times of the day and night. It is recommended that the cannula is replaced and repositioned every 3 days. The choice of pump in very young children should take into account the ability to deliver a very low basal rate.
3.3 Specific but infrequent complications of CSII therapy include reactions and occasionally infections at the cannula site, tube blockage and pump malfunction.
3.4 The pumps usually have a 4-year warranty and in some cases this can be extended by 2 years at an additional cost. CSII therapy also incurs costs for batteries, reservoirs, infusion sets, insulin, lancets, test strips and glucometers for monitoring. The costs of monitoring are common to all forms of insulin therapy. There is also a one-off cost for education of people when starting treatment with a pump, and there are additional costs for continued medical support during the time that the person is learning to become self-sufficient in the management of their diabetes mellitus.