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March 9, 2003

Other

Question from the USA:

I am starting to get nervous about the possibility of war and my daughter getting stuck at school. How do I handle this? Do I leave instructions to start her on shots of NPH with Humalog if she is stuck at school for extended period of time and the pump is no longer working?

Answer:

My approach is, I hope, an effective one — based on my general practice of starting insulin pumps. People have problems with pumps all the time — battery issues, mechanical and other technical problems; pumps in the commode, etc.

I generally do not start pumping until a patient can demonstrate adequate understanding and utilization of another basal/bolus regimen and carb counting. I prefer Lantus (insulin glargine) with Humalog or NovoLog but will sometimes use Ultralente as the basal insulin. I have a current study with NPH as the basal, and it certainly can work also. If they can’t do what I need them to do, I will generally not prescribe a pump.

So when folks call me in a panic about pump issues, I remind them that we already took care of this with insulin injections prior to the pump with their prior basal/bolus regimen. I think it is far easier for families to slide right into the basal with Lantus (or whatever) and continue to bolus (but with injections) for the meals, than forego the lifestyle advantages and flexibility by making them revert to split doses of NPH with Regular, Humalog, or NovoLog.

DS
Additional comments from Dr. Donough O’Brien:

Fortunately I think this is an improbable scenario, but, in a situation like you envisage I thought I ought to sample the thinking of some of the staff. One suggestion was to make sure that your daughter was quite familiar with refilling the pump syringe and as soon as the level of risk seemed high she should carry with her a vial of Humalog, an ordinary insulin syringe so that she could use Humalog by injection as first aid if the pump broke down and also a spare battery, a replacement injection set and pump syringe.

The other suggestion which seemed to come from those who had children with diabetes themselves was that you should do all the above and provide ordinary syringes, vials of NPH and Humalog, along with testing materials. A third suggestion, which these days you may already complied with, would be to give your daughter a cell phone.

DOB