September 9, 1999
Insulin Pumps
Question from Nutley, New Jersey, USA:
My daughter is 8 years old and was diagnosed at age 4. She currently takes two shots of insulin a day. We both tried the pump with a placebo for 3 days. (I am not a diabetic.) Everything about it was great, and she can really use a better method, as her A1c level rose from 7.2 to 9.6 from November ’98 to May ’99, which I believe is due to her lack of exercise in winter months, plus the lack of physical activity in school. (Her sugar has greatly improved during the summer.)
Anyway, the only problem with the pump was with the insertion of the tube. While I found it to be completely painless (I can find enough fat in my abdomen after 3 children), her endocrinologist found that she did not have enough body fat in her abdomen for the automatic inserter, which left us with a nurse who did the insertion manually and on an angle. This was extremely painful for her, and she refuses to consider the pump as long as the insertion must be done this way. Also, her endocrinologist has suggested insertion into her buttocks, which she will not even consider. (I believe she finds it embarrassing.) Is there any other alternative? Her doctor says there is no such thing as a “child-size” inserter. This lone problem has kept her from getting the pump, even though everything else about it seemed great. Right now, our only alternative, I believe, is waiting a year or two until she develops enough body fat to handle the automatic inserter and, I must admit, I was a bit squeamish myself, as a lay person, to think about having to do this for her every other day. Do you have any comment about this situation?
It just strikes me as very sad that a small child does not have the same options as an adult, especially since it could really be a great benefit to her health.
Answer:
I believe the automatic inserter you are referring to is the MiniMed inserter for their “Soft Set” infusion tubing. You are correct that this may not be the best method for someone with very little body fat.
There are many other types of infusion sets available. Chronimed makes many types of infusion sets that you might find useful. They make an infusion set that leaves a small soft tube (similar to the catheter in the MiniMed Soft Set) for the insulin delivery in place under the skin. This catheter is at an angle — so it doesn’t lie as deeply under the skin as the MiniMed Soft Set. In addition, it is placed by hand and doesn’t require an inserter. This must be changed routinely — every 2 days or so. Also, there is a product called “EMLA cream patches” that are available from your local pharmacy (with your doctor’s prescription). EMLA is a topical anesthetic for skin. It is frequently used for IV starts, injections, and any other painful procedure on intact skin. You must put the patch on 1 hour prior to changing the infusion set. If used correctly, the child will not feel the infusion set go in at all.
MSB
Additional comments from Stephanie Schwartz, diabetes nurse specialist:
There also recently has been the development of a smaller Soft Set, called the “Soft Set Micro”, designed for small children. You can contact your local MiniMed rep for more information about this product. The “Tender” from Disetronic could also be helpful.
I agree with Dr. Brown that EMLA patches are a must.
SS
[Editor’s comment: ELA-MAX is an alternative to EMLA. ELA-MAX works in 15 minutes, while EMLA requires about an hour. My personal advice is always to use EMLA or ELA-MAX when inserting a pump infusion set in a child.
JSH]
