My nine year old son was diagnosed with type 1 six months ago. He currently gets two injections per day of NPH/Regular. He and I would like to switch him to an insulin pump. However, it seems to be the philosophy with this endocrinology group, that children are not ready for a pump until at least one year after diagnosis. We want to switch because of the added flexibility and better control. He is counting carbohydrates and demonstrates a good understanding of his disease. We have spoken with several pump representatives and started to educate ourselves on it. It seems like summer would be an ideal time to switch since I can work with him so closely everyday. Is the one year waiting period is the norm for most pediatric endocrinologists? What is the benefit of waiting? What is the criteria for being ready for a pump? Do you have any recommendations for persuading the doctor to switch sooner?

You certainly should read Is the pump right for you? on this web site.

I don’t think that there is a designated time frame that one must endure before considering a pump. Rather, it is an understanding, and a practical application of the principles of pumping that determines a successful candidate. Indeed, we just presented our data at the national pediatric research meetings demonstrating that patients who go directly to pumping from NPH/Regular regimens do LESS well on pumps during that first year of pumping, compared to those patients who first go on to an insulin injection program that uses the basal-bolus principles.

My patients studied had had diabetes for several years and all were essentially out of the diabetes honeymoon. Your child is probably still in the diabetes honeymoon. Others may disagree, but I think pumping while in the honeymoon can give an enormously false sense of security.

Remember that a pump is not an artificial pancreas. It will not automatically give more insulin when your glucose is high; it certainly will not automatically give less insulin when your glucose is low. One must check the glucose not only before meals, but ideally after meals also. If the glucose is high, there is a laundry list of things to do to troubleshoot the pump and try to correct the problem compared to now: if your glucose is high, you simply give an extra shot. In other words, a pump is A LOT of work. It certainly does allow increased flexibility in meals and some activities (have to disconnect for contact sports, water activities, etc).

So, I’d suggest that you maintain an open dialogue with your diabetes team who has more experience with pumps than you do at this time. They may not be so rigid in their approach as you might think. But, I would strongly suggest that if want to experience the dosing approach to pumping, without the pump, you ask to begin a basal-bolus insulin plan. This will involve the use of a very long lasting, essentially non-peaking insulin (such as insulin glargine [Lantus]) in conjunction with multiple shots of fast-acting insulin (such as Humalog, NovoLog, or maybe even Regular) to be dose with EVERY meal, but based on your carbohydrate intake. Right now, I’d wager that while you may be tracking carbohydrate intake, you’re not doing anything really with that information. If you can count carbohydrates accurately, and dose insulin appropriately and accurately based on the carbohydrate counting, then you may be ready to pump.

DS