My beloved three year old nephew was diagnosed with type 1 diabetes around 10 days ago. My sorrow is beyond belief. After spending some time on the web, we decided that CSII therapy is a must and OmniPod is THE choice. But, it turns out that the OmniPod is not yet distributed outside the States. The FDA has approved it just for use in the States. And, naturally, a prescription is needed. But, we are living in Iran and speaking English is not a barrier for us. We are quite capable of contacting OmniPod customer support or reading/applying OmniPod manuals and whatnot, and we are ready, willing, and able to pay for the PDA, the backup PDA, and test tape and supplies of one full year. Plus, we do have relatives/friends inside the States to buy/send us the product. Despite all these things, OmniPod says they can’t let us have it unless we are there, in the U.S., and we have a prescription written by a physician inside the states. I phoned OmniPod’s customer support a couple minutes ago. They said there is no way on earth they’re going to send us the product. Well, it’s reasonable, but I wish they could see this little child’s face from his uncle/parents’ point of view. I’m so down I can barely breathe. Can you think of a way to get around this? How can we possibly have this OmniPod despite the aforementioned criteria? We’re going to need your help. Will you help us?

I understand your genuine sorrow and shock about your nephew’s recent diagnosis of diabetes mellitus.

While insulin pump therapy may certainly be an option for him in the future, perhaps the not-so-distant future, I strongly urge you and the family to first become superiorly knowledgeable about the principles behind pump therapy, namely basal-bolus insulin dosing. This can be done by insulin injections and, I think, should almost always precede going directly to a pump.

An insulin pump is, of course, NOT an artificial or mechanical pancreas. It is only a device which can malfunction. If that were to happen, the child would need to receive insulin injections by needle again.

My own data show that diabetic children who were advanced too quickly to pump therapy have poorer glucose control compared to those children who preceded their pump therapy with basal-bolus insulin by multiple daily injections.

I do not disagree, however, that the OmniPod is a provoking device!

DS
Additional comments from Dr. Linda DiMeglio:

I am not sure exactly how to help you get an OmniPod in Iran, but I wanted to respond anyway because, although it’s not yet available in our area of the U.S., I do have some general reservations about it for very young children. The device is large (about 2 l/2 inches by 1 1/2 inches by 1/2 inch, I think – I’m sure the dimensions are available on line) and I think attaching something that size semi-permanently onto a young child will not be easy.

I know insulin injections are not easy in young children, but I think injectable insulin will be more reliable in the short term than a new technology like the OmniPod. Once your family is comfortable with carbohydrate/insulin ratios and corrective doses, you might want to consider a more traditional pump for him, making sure to get one that has low basal rates and boluses available.

LAD
Additional comments from Dr. Larry Deeb:

I would counsel that taking a device far from support to a place where no one knows how to use it correctly is taking a huge risk, and that risk is compounded by the age of the child.

One must remember that the reports of successful use of pumps in children and in very little children come from places where experts have literally decades of experience and have evolved in the therapy. While they show us it is a safe and effective treatment, they, too, counsel such use is only in the context of a dedicated, educated and committed full time 24/7 team for a family.

I would never dump a pump on a family in a far away place. New diabetes is a huge trial for the family with a toddler. Much love and support from the diabetes team is essential to transfer knowledge and compassion. It is much more than the device.

LD
Additional comments from Jane Seley, diabetes nurse specialist:

I have thought about this carefully and really think that helping to get an OmniPod with no technical support for such a young first time pump user is not advisable. I would recommend choosing a pump that is distributed in Iran and has easy to access technical support. If provided with a list of the available pumps in Iran, the diabetes team could assist in choosing the best fit for the child.

JS