January 28, 2003
Question from Lowell, Arkansas, USA:
My 23 month daughter, diagnosed with type 1 diabetes at 16 months of age, is taking Humalog, NPH and Lantus in three injections daily. We carb count carefully and closely monitor her blood sugars (six to eight readings per day), but her blood sugars are extremely erratic, and we cannot figure out what is going on. She can be over 300 mg/dl [16.7 mmol/L] and two hours later be below 90 mg/dl [5 mmol/L]. Our endocrinologist has said that he would consider the pump for her when we are ready, and we will do anything to have better control of her blood sugars. Do many endocrinologists recommend the pump for such a young child? Would pumping keep her blood sugars in better control than injections?
I might focus first on a different insulin regimen. If you’re doing three injections daily (and even if two are mixes of Humalog with NPH and the third is Lantus [insulin glargine]), it might be better to either switch to Lantus once or twice daily and give her Humalog every time she eats a meal (to mimic an insulin pump by using Lantus as her basal insulin) or move her NPH to bedtime (or switch it to Lente) to get better control of her morning numbers.
A pump may be a viable option, but involves a great deal of work and requires finding a center that has experience with pump therapy in toddlers — since toddlers have very different insulin requirements on pump therapy than do older children or adults. As to which provides better control, there is currently no data published that directly compares pump therapy to intensive insulin therapy in these very young children with diabetes. (We’re finishing a study — stay tuned!)