Getting a pump or CGM on the NHS: the criteria, the conversation, and what to do if you’re told no
How do I actually get a pump or CGM on the NHS? What are the criteria and how do I ask?
A continuous glucose monitor (CGM, the sensor that reads your glucose without a finger prick) is now offered on the NHS to everyone with type 1, so if you do not have one, you are entitled to ask. Insulin pumps and hybrid closed-loop systems (a pump and sensor that adjust your background insulin automatically) have criteria you need to meet, and the closed-loop kit is being rolled out in stages, so waits are real. You do not need perfect numbers to ask, and a no first time round is not the end of the road.
- CGM is now for all type 1s: national guidance recommends a sensor for every adult and child with type 1, so it is something to expect, not to earn.
- A pump is usually funded when a high HbA1c (your average glucose over about three months) stays high despite real effort, or when hypos (a glucose below 4 mmol/L) are frequent or frightening.
- Hybrid closed-loop is being rolled out in phases, with some groups seen first, so timing varies a lot between areas.
- Going in prepared, with your readings and clear examples of what you find hard, makes the conversation far easier than turning up cold.
- If you are turned down, you can ask why in writing, request a second opinion, or ask to be referred to a specialist centre.
CGM is now offered to everyone with type 1
For years a sensor was something you had to qualify for. That has changed. National guidance now says the NHS should offer a continuous glucose monitor to every adult and child with type 1, whether that is a real-time sensor that streams to your phone or a flash sensor you scan. The point is that living with type 1 is itself the reason, not a high HbA1c or a run of frightening hypos.
In practice this means that if you are still finger-pricking and want a sensor, you can raise it at your next appointment and expect a genuine conversation, not a fight. There can still be a wait, a choice of which sensor your area offers, and some training first. But the starting point is that you are eligible, so you are asking for something you are entitled to, not making a special case.
Pumps and closed-loop: what clinics look for
Insulin pumps and hybrid closed-loop systems still have to be justified, because they cost more and suit some people better than others. Broadly, a pump is considered when your HbA1c stays high despite genuinely working at it, for example careful carb counting and frequent checking, or when hypos are frequent, severe, or so unpredictable that they limit your life. You do not have to be doing everything perfectly: the criteria are about need, not merit.
Hybrid closed-loop, the pump-and-sensor setup often called an artificial pancreas, is newer and being introduced across the NHS in stages. Some groups tend to be offered it sooner, such as children, people who are pregnant or planning to be, and those whose levels are hardest to settle. That staged rollout is why one person gets a call quickly and someone similar in another area waits: it is about the local queue, not about you.
How to prepare for the appointment
The clinic decides eligibility, but you shape the conversation, and coming prepared makes a real difference. Bring your glucose data if you have it, from your meter, sensor or app, and be specific about what is hard: the 3am hypos you cannot predict, the mornings you wake high, the fear that stops you exercising, the shift work that wrecks your routine. Concrete examples land far better than saying you are struggling.
It helps to state plainly what you are asking for and why you think it would help, whether that is a sensor, a pump, or closed-loop. Ask what the criteria are where you live, what the waiting list looks like, and what the next step is. Writing your points down beforehand, and taking someone with you if that helps, means you leave having actually asked, rather than remembering it all in the car park.
What to do if you are turned down
A no is not always final, and asking to understand it is completely reasonable. You can ask for the decision and the reasons in writing, and ask exactly which criterion you did not meet, because sometimes it is something that changes, like needing to try a sensor first or gathering a few months of data. If you disagree, you can ask for a second opinion or to be referred to a specialist diabetes centre, which often has more experience with pumps and closed-loop.
Your GP can help chase referrals, and your hospital PALS (the Patient Advice and Liaison Service, which helps patients deal with the system and raise concerns) can help if you feel stuck. Diabetes UK runs a helpline and has detailed guides on the current criteria, worth reading so you know where you stand. Criteria and rollouts change over time, so a no this year can become a yes when the next stage opens or your circumstances shift.
What changes how quickly this happens
Access is not uniform across the country, and that is the honest truth of it. Different areas are at different points in the closed-loop rollout, offer different sensor brands, and have different waiting lists, so two people with the same story can have very different timelines. Being pregnant or planning a pregnancy, or being a child or young person, often moves you up the list. None of this reflects how deserving you are, it reflects the system you happen to be in.
How these conversations tend to go
Examples, not instructions or doses.
You have finger-pricked for years and did not realise the guidance had changed. You mention at your review that you would like a sensor, and instead of a debate you are put forward for one, with a short wait and some training first.
You bring three months of readings showing repeated night-time hypos you cannot predict. Those concrete patterns, rather than a general sense of struggling, are what your team needs to put a pump case together.
You are told you do not yet meet the closed-loop criteria in your area. You ask what would change that, gather more data, and are offered it several months later when the next rollout stage opens.