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November 4, 2002

Daily Care, Insulin Pumps

Question from Lancaster, California, USA:

My daughter sees a pediatrician for all of her needs and has only seen the endocrinologist in the hospital when she was diagnosed. Her blood sugars are good for a few days, then we are in the high range again. She has a very restricted diet, and she is on sliding scale Humalog and NPH, which I keep trying to adjust, but it isn't working well. We tried to get her an insulin pump about eight months ago, but they told me her C-peptide level was 0.07 and their requirements were 0.05. What does this mean? Is there another way to get her better medical care? Is there financial aid out there for us to help her get the pump?

Answer:

Sounds like glucose control is not optimum. I would suggest your arranging for a consultation with a pediatric diabetologist and then problem solving with this diabetes team. All of what my team and I have written for many years suggests that children and adolescents with diabetes should receive care from dedicated pediatric/adolescent diabetologist and a multidisciplinary team. We (Brink, Moltz, Miller) just published a review of such multidisciplinary care in the Journal of Pediatric Endocrinology and Metabolism, October 2002 issue.

Whether or not an insulin pump is the correct next step requires some detailed evaluation, review of blood glucose home monitoring logs and reassessment of diabetes skills and education. The actual C-peptide level has nothing to do with who should use an insulin pump, it’s only with an approximation of how much the body can produce insulin on its own.

SB

[Editor’s comment: All of the pump manufacturers will work with you regarding finances.

SS]