July 1, 2003
Insulin Pumps
Question from Barksdale AFB (Shreveport/Bossier City), Louisiana, USA:
Our three year old daughter, diagnosed five months ago, is quite inquisitive and has never really been brought under control despite several changes in her insulin. She is currently on NPH with Humalog at breakfast, Humalog at supper, and NPH at bedtime along with a sliding scale of Humalog which we have to use almost every time we inject her. I am seriously wanting to change something about her care, as increased insulin doses do not seem to be working, and I am considering pump therapy as a possible way to get her under control, but I’ve had mixed opinions from her endocrinologists and pediatrician.
The pediatrician thinks pumps are great and are the cutting edge of diabetes care, but the main diabetes team we see is in Dallas and strongly opposes pump therapy in one so young. The local endocrinologist doesn’t oppose pump therapy in a child her age, but believes that injections are just as good and pump therapy has its own drawbacks, etc. He didn’t seem to have a set opinion either way but is willing to prescribe one if I believe it’s best (I do like hearing that).
My own concern is, how would I keep her from tampering with the buttons, removing the infusion set, etc.? I know there are lots of kids out there at this age with pumps. How do their parents manage to keep normal, curious, fidgeting little kids from tampering with the pump? I’ve tried finding out by researching and asking around, and it’s amazing to me that I have not been able to find out much on this particular issue, so your opinion will be very greatly appreciated.
Answer:
Rather than jump to a insulin pump, I’d start by having your diabetes team teach you how to do carbohydrate-insulin ratios and a “corrective dose” rather than a simple sliding scale. This may be enough to help even out her blood sugars a bit (and be knowledge that you’d need anyway before going on a pump).
LAD
[Editor’s comment: Pumps have been used successfully in children this age. Several brands have “lockout” features to prevent small children from playing with the buttons, and newer models have many additional safety features. You might wish to look at the websites of the various manufacturers to see what is available, and perhaps even contact local representatives for “live demonstrations”. I also suggest you visit the Chat Rooms at this website and discuss this with parents of children this age who are pumping.
SS]
