My four year old girl was diagnosed with type 1 diabetes about five months ago, and while I have been told that her diabetes is considered “controlled”, she frequently has lows (under 4 mmol/L [72 mg/dl]) as well as highs (over 10 mmol/L [180 mg/dl]) on a daily basis. She is on Humalog and NPH twice daily, and I would like to get her on a pump as soon as possible, but her doctor does not want to yet as she considers it controlled. Is this appropriate? What are the contraindications to pump therapy? All the literature makes it sound great. Should I be pushing for the pump a little harder or find a new doctor? When she is high she becomes belligerent and gets herself in to trouble. Is this not a good enough reason to try the pump?

The insulin pump can be a safe option for a pre-school child with diabetes, but, by itself, will not solve all your daughter’s blood sugar variability. Since your child is newly diagnosed, and you’re likely still learning nuances of her diabetes management, I’d suggest working first with her diabetes team to optimize her blood sugar control on injections before jumping to pump therapy.

Steps in optimizing control might include further carbohydrate counting and food/activity record-keeping, changing types of injectable insulin (There are many different insulins that may offer better blood sugar coverage), starting a sliding scale for short acting insulin, learning carbohydrate/insulin ratios, and learning to do corrective doses (to give the sliding scale more flexibility). Once you’ve mastered these skills, then pump therapy may still be attractive as a way of allowing you greater flexibility in lifestyle/food/and insulin adjustment. Unfortunately, without these other tools, the pump itself does not provide a panacea.

LAD