September 16, 2003
Insulin Pumps
Question from Charleston, South Carolina, USA:
My 11 year old daughter, diagnosed about two months ago, was put on Regular, NPH, and a sliding scale of NovoLog at breakfast and dinner. However, her blood sugars were off the charts in the morning so our nurse practitioner has changed her dose more than 10 times. Her NPH was increased and switched to bedtime, and she has had dips at 2:00 am, so the NPH was lowered again which has helped not to have lows, but we still have the crazy highs in the morning. Our practitioner says she’ll probably switch her to Lente, and if this doesn’t work, possibly going ahead and getting a pump, but I’ve read it’s not a good idea to get a pump for at least six months because you don’t know if the pancreas is completely finished. Any thoughts?
Answer:
It sounds like you are getting good advice from your diabetes team. Lantus would also be a good consideration to avoid middle of the night insulin peaks but provide better next morning insulin coverage. Many pediatric diabetes teams, including our own, have had more than two years experience with Lantus with good results, more stable blood glucose levels, fewer overnight hypoglycemic episodes and better dawn/early morning coverage.
When an insulin pump is recommended is very individualized and depends upon family, child and diabetes team experience and comfort. There are no dogmatic rules required — just analysis of what is working and how best and safely to reach glycemic goals.
SB
