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February 4, 2006

Insulin Pumps

Question from Sugar Land, Texas, USA:

My 20 month old baby has type 1 diabetes. She has had it less than three months. I would like to know if it is good for her to use a pump now instead of taking injections.

Answer:

There is no “right” answer to your question, just as there is no good answer to the question of who will ultimately succeed or fail on pump therapy. One note, however, is that many diabetes centers, including our own, won’t consider pump therapy until children have been diagnosed with diabetes for at least a year.

Why wait a year? First, it gives you time to make sure that you’ve maximized your knowledge and the way you’re using injected insulin. You should make sure that you’re counting carbohydrates and using carbohydrate/insulin ratios and corrective doses. You need to understand how insulin works and how to trouble-shoot illnesses. You also would need to ensure that her daycare providers, if there are any, are also comfortable with calculating insulin doses and trouble-shooting when necessary (able to check blood sugars and ketones).

If you’ve done all that, her numbers are still erratic, and you’re still thinking about a pump, it’d be important to discuss your daughter’s diabetes with members of a health care team that feel comfortable managing a very young child on a pump. This is because just as the blood sugar target ranges are different for toddlers than older children or adults; the insulin requirements of very young children on pumps are very different than in older individuals. A few centers are doing studies in pump therapy in very young children; some others are gradually gaining experience as pump therapy becomes more popular.

LAD