I have a young friend, age 8. She lives with her grandmother in poverty. I don’t know which type of diabetes she has but her grandmother always gives her insulin after she eats. I have heard there is an implant that can administer insulin on a regular basis. Is this true? Is it available for a child and do they have proven reliability?

It is not unusual nowadays to give insulin after the meal. One of the relatively new insulins (called lispro or Humalog) is a modification of human insulin that starts to work in about 10 minutes and only lasts for four hours: this means you can adjust the dose according to the premeal blood sugars as well as appetite.

At the moment, there is no way in which insulin can be implanted so that its effect lasts for days or weeks and also accommodates to changes in blood sugar. Transplants at the moment are unsuitable for children because of the need for immunosuppressive drugs though there are still hopes for success with encapsulated porcine xenotransplants. Pumps have been used satisfactorily in some 8 year olds but their use needs to be initiated by a team with experience both with pumps and with that age group and especially at the beginning you need to be sure of easy communication by telephone, fax or e-mail. Not many grandmothers are likely to be comfortable with responsibility for such devices.

I wonder if this little girl might be eligible for Medicaid and even if she is not all States have special Federal funds for children’s health care in families just above the poverty line.

DOB