A friend’s 12 year old son uses a pump. He is allowed to eat whatever he wants(cake, pie, candy) and a lot of it from what I see. He is very overweight and is about to begin growth hormone treatment. His parents tell me he can eat what he wants because “that is what the pump is for” — is that true?

Please search this website for similar questions about this common misunderstanding. Your friend is somewhat correct but also incorrect.

With virtually any type of basal/bolus insulin plan, whether it be by multiple daily injections with combinations of very long and very rapid-acting insulins, or by insulin pump therapy, the person with diabetes has more flexibility to eat at variable times and to eat more foods, so long as they appropriately bolus insulin with food intake. That is not the same as they can eat “whatever they want.” Some people do misunderstand and take advantage of the flexibility somehow thinking that the insulin pump is an artificial pancreas and will make appropriate adjustments automatically to keep the glucose in the right range. It is not and does not. It is simply a tool: a helpful tool, to be sure. People with diabetes must still watch food intake for a good balance.

DS
Additional comments from Dr. Andrea Scaramuzza:

In my experience, the pump can allow a more liberal meal plan, but this does not imply that this child can do whatever he wants. In addition, because you say he is overweight, this is certainly a good reason to watch things because he can have much tighter control and a much healthier meal plan.

AS
Additional comments from Dr. Donough O’Brien:

Although at first glance there seem to be some inconsistencies in this story, the diabetes, the obesity and the implication of short stature and extravagant appetite are entirely consistent tith the Prader Willi syndrome, a condition that was first described by two Swiss paediatricians a little over thirty years ago. Although uncommon, it is easily recognized and I would have expected that this boy’s diabetes care team have already made such a diagnosis and discussed it with the parents. The use of a pump to control blood sugars in the face of an insatiable appetite makes good ense as does the use of growth hormone which is now normal practice for the short stature, that is another feature of the syndrome.

DOB
Additional comments from Joyce Mosiman:

The pump offers people a lot of flexibility. This is a good thing as long as it is not abused. Just like people who don’t have diabetes, whatever we eat is accommodated by insulin — the flip side of that is when limitless amounts of foods are eaten the excess calories build up as excess weight which is never a good thing.

I believe moderation is the best solution to eating. Foods with sugar and highly refined carbohydrates are not nutritious and should play a limited role in daily eating. Foods at the top of the Food Guide Pyramid should be considered as occasional additions to daily eating.

JM
Additional comments from Lois Schmidt Finney, diabetes dietitian:

There seem to be many misunderstandings and problems here. I hope the family is being followed by a diabetes team. I do not know of what you can do or say, but your concern for the young man and the family is fabulous, so if they ask for your ideas or your help, please tell them to contact us here or their diabetes team.

LSF