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July 31, 2002

Insulin Pumps

Question from :

Philadelphia, Pennsylvania, USA: My four year daughter, diagnosed with type 1 diabetes about 17 months ago, is currently taking three to four insulin shots per day with hemoglobin A1cs ranging 6.4%-7.3%, but it is getting harder and harder to control her sugars. Also, since she is on Humalog with NPH, we are always feeding her, and she is gaining quite a bit of weight. Right now she is on 2 units of Humalog with 3 units of NPH at breakfast, 1.5 units of Humalog with and 1.5 units of NPH at dinner, and 1 unit of NPH at 11pm. We would like to have her on pump therapy but her diabetes team is not thrilled with pump use in children. They are now also saying she is not on enough insulin per day to be able to use the pump. They believe she is still in her honeymoon period and needs to be taking approximately 15 units of insulin per day before pump therapy is an option. They also dismissed using Lantus, saying they do not get good results with it, and NPH with Humalog is still the best option for my daughter. My wife wants to change doctors. Have ever discouraged pump therapy based on their being in the honeymoon period or just needing small amounts of insulin?

Answer:

Since your daughter is currently on fixed doses of insulin, it sounds like she may benefit more immediately from being placed on an insulin to carb ratio with corrective doses of Humalog or NovoLog so that she can vary her food intake depending on what she wants to eat and what her blood sugar is. This may help you from having to overfeed her lows.

Once you learn how to do this, insulin pump therapy or therapy with a long-acting insulin such as Lantus (insulin glargine) or Ultralente may be a more viable option.

It is important, however, when considering pump therapy in a child who is just about to start school (even preschool) that a school plan for insulin administration, carbohydrate counting, and troubleshooting be in place long before the school year begins.

LAD