I know of several people who were made to wait years, some who were made to wait because of poor control, and some who have gotten pumps within a month or two of diagnosis. I do know there are other factors in “candidate selection” (maturity, parent involvement, desire for the pump, etc.), but I was severely reprimanded at work for talking about a pump with a newly diagnosed child, and I am looking for some back up on my position which is that a pump is appropriate if the parents are willing, the child is motivated, and the doctor has experience in managing pumps. What is an appropriate length of time between the diagnosis of diabetes and the initiation of pump therapy?

There is no good answer to this question — just as there is no good answer to the question of who will succeed or fail on insulin pump therapy. In general, to use a pump optimally, children and their families need to be able to carb count and use carbohydrate/insulin ratios and corrective doses. They also need to understand how insulin works and how to trouble-shoot illnesses and pump issues (such as site problems and pump failures).

The health care team also needs to be assured that the family will stay with their group long enough to get all the teaching done, and the pump properly adjusted. Also, many patients have a very nice honeymoon period after diagnosis during which they may need very little insulin and have very stable blood sugars without a great deal of effort – making pump therapy less attractive.

For these reasons, in our clinics, families are not eligible for pump therapy until they have been diagnosed with diabetes at least a year. I know that there are people who would start pumps sooner (an Italian group has published studies looking at pump starts at diagnosis) and some who would wait even longer (perhaps only offering pumps to adolescents).

LAD

[Editor’s comment: Sad to say but there are numerous possible reasons for the discrepancies in how fast pumps get started — some are truly medical issues (such as those described by Dr. DiMeglio); often there are financial issues (who’s paying — an insurance company? a National Health Service? the patient and family?), and just plain ignorance (such as physicians who don’t understand pumps but pontificate about their opinions — for example, any doctor who categorically states that pumps should not be used in children).

WWQ]