November 29, 2005
Insulin, Insulin Pumps
Question from Midlothian, Virginia, USA:
My five year old niece was diagnosed with type 1 diabetes last week. What do you think of NPH and Humulin insulin versus Lantus and NovoLog. Would it not be better to start out with aggressive treatment with Lantus and NovoLog? Also, what should her A1c be at this age? I know that for adults, it is below 7.0, although I thought it was different for children. What are your thought about starting an insulin pump within six months of diagnosis?
You are asking a question that needs to take the individual, patient and family, into account. Early in diabetes, almost any management “works.” I look at willingness and ability. As a physician, I must take care of the patient and family first and the actual management comes second. One must assess the willingness of the family to do the things asked. Willingness is a feature. Some will not take shots at school. Ability also comes into play. The family must be able to make frequent adjustments with “flexible” management with rapid acting insulin and Lantus. Some just cannot do the calculations. We need for each to succeed. Some become more able as they live with diabetes. Again, individual care is the key.
Pump therapy works for many, but not all. Personally, I like to introduce it after some time of adjustment and learning. The pump adds a new layer of complexity and learning needs. For most, it is worth the investment. The family must talk to the doctor about its desires and be realistic. Remember, you are asking a question about someone who doesn’t live with you every day.