My eight year old son, who has had type 1 a little over a year, started using the pump two months ago, and often forgets to bolus at school for lunch (or any other time I am not with him). Do you have any helpful hints on how to handle this?

The issue of how to remind an eight year old to bolus is an important one when considering insulin pump therapy in children that age in general. An eight year old on shots is not old enough to give his own injections without supervision and, similarly, an eight year old on a pump is not old enough to calculate a carb/insulin ratio or corrective dose on his/her own or old enough remember to bolus.

Unfortunately, it sounds like this issue was not considered carefully before your son went on his pump. At this point, I would advise you to find an adult at school or when he is away from you who can calculate and supervise his boluses. If this is not possible, you have the (non-optimal) option of programming the pump to give a bolus (by increasing the basal rate for the time over lunchtime) or putting your child on injections for the daytime and using the pump only at night. See Use of insulin pump therapy at nighttime only for children 7-10 years of age with type 1 diabetes, Kaufman F, Halvorson M, Kim C, Pitukcheewanot P., Diabetes Care 2000; 23(5):579-582).

LAD