The aim of this guide is to help you decide what diabetes technology you would like to use. It has been designed to be viewed online so you can follow the hyperlinks to additional information.
Diabetes management
There are different ways to deliver insulin and measure glucose levels using technology. This guide has been created to help you choose between the options available to you. NICE Technology Appraisal TA943 recommends that Hybrid Closed Loops systems are used by children and young people to manage Type 1 diabetes.
Diabetes management technology includes insulin pumps and glucose sensors. Hybrid closed loop systems (HCL) use a pump, a sensor and an algorithm to adjust insulin in response to glucose levels. To decide what technology you would like to use, you need to think about which sensor, pump and system you would like to use.
The latest diabetes technology is called a hybrid closed loop system (HCL). The glucose sensor and insulin pump are communicating with each other every 5 minutes.
The algorithm in the insulin pump uses the sensor information and adjusts insulin delivery automatically. If your glucose is rising, it will increase insulin delivery or deliver an additional bolus as a correction. If your glucose is falling, it will decrease or suspend insulin delivery.
With all HCL systems, it is still necessary to tell the pump when you are eating by entering the carbohydrate into the pump and giving a bolus of insulin 5 –15 minutes (depending on the type of insulin) before you eat. This helps the system work efficiently and can prevent delayed hypoglycaemia.
If you wish to use a HCL system, then it is important that you use a sensor that works for you. To get the best from the HCL you should wear the sensor at least 90% of the time.
You can learn more about HCL here
There are currently 4 HCL systems available at UCLH.
Continuous glucose monitoring (CGM) automatically tracks glucose levels throughout the day and night. There are two types of CGM. Real time CGM (rtCGM) where the glucose levels are transmitted to a receiver/mobile device continuously (every 5 minutes) or intermittent CGM (isCGM) where the sensor must be scanned to check glucose levels.
NICE guidelines (NG18) recommend that real time CGM is offered as first line treatment choice to all children and young people with Type 1 Diabetes.
Real time CGM available at UCLH
- Dexcom G6. Has a sensor and a separate transmitter Can be used with hybrid closed loop systems. Has a follow function that allows parents/guardians to ‘follow’ the data from the sensor.
- Dexcom G7. Sensor with inbuilt transmitter. Can be used with a stand-alone pump or with multiple daily injections. Has a follow function that allows parents/guardians to ‘follow’ the data from the sensor.
- Medtronic Guardian™ 4. Sensor with separate transmitter. Can be used with Medtronic MiniMed™ 780G system or InPen™ Smart system. Has a follow function that allows parents/guardians to ‘follow’ the data from the sensor.
- Medtronic Simplera Sync sensor used with the Medtronic 780G or Simplera sensor used with InPen Smart system.
- Freestyle Libre 3 – A 14 day sensor compatible with the Ypsopump and mylifeCamAPS HCL system.
Real time CGM available from the GP
- Dexcom One Plus A 10-day sensor. Not compatible with any pumps or HCL systems, fewer alarm options than the Dexcom G6 and G7.
- Freestyle Libre 2 Plus - A 15 day sensor used with LibreLink app that has alarms and follow functions. Can be used with the Omnipod 5 HCL system but there is no follow function when used with Omnipod 5.
Intermittent CGM is available on prescription from the GP.
- Freestyle Libre 2 Plus. Sensor with inbuilt transmitter, if used with a reader does not have any follow functions and sensor needs to be scanned. This option is not available with the Omnipod 5 HCL system.
An insulin pump is attached to the body via a small cannula. It is worn 24 hours per day. It delivers small amounts of insulin continuously using programmed basal rates. When you eat, you use a bolus calculator to enter the carbohydrate and deliver a bolus of insulin.
Insulin pumps can be used as a stand-alone device alongside CGM (glucose is manually entered into the pump) or used as part of a hybrid closed loop system (glucose data transmitted to the insulin pump).
Insulin pumps are currently offered with a 4 year warranty/funding cycle, this means once you have chosen the pump manufacturer you will not be able to move to a different system for 4 years under current NHS funding arrangements.
Insulin pumps available at UCLH
If you choose not to use a hybrid closed loop system or stand-alone pump, the alternative is MDI.
You can use rtCGM alongside MDI. The options are:
Dexcom G7 with smart insulin pens (Novopen Echo Plus® and Novopen 6®) and a bolus calculator app.
Medtronic InPen™ Smart Insulin Pen System. This is a combination of the Medtronic Guardian™ 4 sensor alongside the InPen™ Smart insulin pens and an app. The CGM transmits glucose to the app which advises when and how much insulin to give, by injection. When you eat, you use a bolus calculator in the app to enter the carbohydrate and calculate the insulin dose. Long-acting insulin injections are still required.
If you are thinking of choosing a HCL system, use the following table to decide which features are important to you.
You can follow the links for more information:
|
Features |
Medtronic MiniMed™ 780G |
Tandem T:Slim X2 |
Ypsopump |
Omnipod 5 |
|---|---|---|---|---|
|
HCL technology |
SmartAdjust™ |
|||
|
Glucose sensor |
Guardian™ 4 Simplera Sync |
Dexcom G6 Dexcom G7 |
Dexcom G6 Freestyle Libre 3 |
Dexcom G6 Freestyle Libre 2 Plus |
|
Licensed age group** |
7 year and over |
6 years and over |
1 year and over |
2 years and over |
|
In warranty software updates |
Yes |
Yes |
Yes |
Yes |
|
Tubed pump |
Yes |
Yes |
Yes |
No |
|
Remote bolusing |
No |
No (expected 20205) |
Yes |
Yes |
|
Mobile phone required for HCL to work |
No But needed for follow option |
No But device with G6/G7 app |
Yes Android only |
Yes Dexcom G6 No with Freestyle Libre 2 plus |
|
Follow option |
Yes Carelink Connect app |
Yes Dexcom Follow app (only if user also carries a device with G6/G7 app) |
Yes Companion app (android only) OR Glooko app |
Yes Dexcom Follow app (only if user also carries a device with G6 app) |
|
Cannula options |
Inset II |
N/A |
||
|
Cartridge size |
180 units 300 units |
300 units |
160 units (prefilled Novorapid or self-filled) |
200 unit reservoir within each Pod |
|
Can be used as a stand-alone pump? |
Yes |
Yes |
Yes MyLife app is required for bolus advice |
Yes |
** In paediatric care, doctors often use medicines 'off license', based on international practice and published evidence, we may recommend pumps off license.
This table provides more detail about features of the different systems:
|
|
Medtronic 780G with SmartGuard |
Tandem T:Slim X2 with Control IQ |
Ypsopump with CamAPS FX |
Omnipod 5 with SmartAdjust |
|
Training requirement |
Pump school and workbook to be completed for all systems before pump start or pump upgrade |
|||
|
|
|
Online training module certificate required |
|
|
|
Are the basal rates used in the algorithm |
No |
Yes |
No |
No |
|
All basal profiles must be kept up to date for times when not in HCL |
||||
|
Glucose target |
5.5, 6.1 or 6.7mmol/L |
6.3mmol/L |
User can choose glucose target |
6.1, 6.7, 7.2, 7.8, 8.3mmol/L |
|
Additional features |
Temporary target can be used to reduce insulin delivery e.g. for prevention of hypos during exercise. No corrections given when temporary target set. |
Sleep activity: Narrows target range for sleep but will not give correction boluses. Exercise: Higher treatment range 7.8 -8.9mmol/L correction boluses will still be given |
Ease off and Boost functions to allow for management of exercise, stress and illness etc. |
Activity feature can be used to raise glucose target to 8.3mmol/L and adjust algorithm responses to glucose levels. |
|
Uploading |
Automatic uploads to CareLink Personal if using the CareLink app If app is not being used, blue dongle is supplied with new pumps to upload to a computer |
Micro USB cable required to upload to Glooko |
Automatic uploads to Glooko |
Automatic uploads to Glooko |
Emergency mobile: 07940 476811
Email: uclh.
Further information and fact sheets can be found on our Children and Young People’s Diabetes web page.
Page last updated: 30 October 2024
Review due: 01 October 2026