September 19, 2002
Insulin Pumps
Question from Rockford, Illinois, USA:
My 10 year old boy has type 1 diabetes, and my husband and I are currently going through a rough divorce which has rocked my child’s life in a big way. He has a lot of anger about the divorce and is transferring that anger toward his disease, toward me, and toward his little brother. He is checking his own sugar and giving himself insulin injections. That’s a great thing! However, the fact that I have to constantly remind him to check his sugar and give insulin causes conflict. Some of this stems from the fact that our family is going through change.
In addition to all that is going on in our family, my two children and I are going to counseling for help with a lot of the anger issues, and my son has been diagnosed by the psychiatrist with mild depression and is on medication. In a nutshell, he is having a hard time, and his sugars are out of control.
His blood sugars average in the 200s [mg/dl, 11.1mmol/L] most days, and his hemoglobin A1c is 8.5%. My husband and I have talked with his doctor about the insulin pump, but the doctor didn’t recommend it because of the instability in our family life. He tended to think that adding the pump would be too much for my son at this time with all that is going on. I was thinking that the pump would help manage his diabetes so that when he is stressed out and having a bad time his sugar would be better regulated. What do you think?
Answer:
While an insulin pump may indeed be ultimately a good thing for your son and his glucose control, it is a lot of work and requires a lot of self-reliance. If he thinks (or you think) that he is already being scrutinized about checking glucose levels and taking insulin with shots, this will increase three to four-fold while on a pump –at least for the first several months. I don’t think I would start an insulin pump, with it’s constant infusion of insulin, and the ability to change doses in a newly depressed, perhaps unstable child.
You did not indicate the insulin regimen your currently is on, but if he is not not already on a basal/bolus program using Lantus (insulin glargine) or Ultralente as the basal insulin, along with lispro (Humalog) or aspart (NovoLog) insulin as the bolus insulin with meals, based on carbohydrate counting, this might be a good compromise. If he be successful with basal/bolus, then I would anticipate success on a pump, but for now, based on the above, I think a pump is not completely wise.
DS
