My teenage son’s doctor will not consider a pump because he is in poor control. He sees the pump as a way for someone who’s already well-controlled to become better controlled; not as a way for someone in poor control to become controlled. However, I’ve read that some insurance companies will approve a pump only if the patient is in poor control. People have also stated that going on the pump was the single thing that made it possible for them to bring diabetes into control — not just better control, but from previously poor control to current good control.

So, people in poor control have definitely been okayed to use the pump. I believe the doctor is refusing to consider the pump because he believes the present blood glucose readings indicate lack of responsibility and compliance, and that if there in non-compliance, on the pump there could be serious problems. I understand that. Of course, without the doctor’s agreement, there’s no way it will happen.

What is your opinion on putting a teen who is in poor control (on three to four shots per day) on the pump?

Without interviewing your son, I have no idea what kind of control he is in, how has he has tried to achieve reasonable control, and whether or not he wants an insulin pump.

If you want him on the pump, and he does not, I would not start him on it. He must be the one to take care of it and himself. If he wants the pump, I bet he will try to get in better control through using the guidelines of his diabetes team. Remember, he will need to work with this team after he starts on the pump since there will be challenges.

As to your question, I have worked with some doctors who feel that pumps can help a person go from poor control to tight control, but most doctors feel that someone must be in at least reasonable control doing multiple injections, blood glucose testing, etc. before they will give an okay for the pump. So, I would tend to err on the side of being conservative and having your son be able to show he can do what is needed for at least reasonable control first. If he is not currently doing at least blood glucoses a day and adjusting insulin per the directions of his diabetes team, I find it hard to see how a pump is justified.

As far as I know, pumps do not achieve significantly better control than multiple daily injections, but they offer much more flexibility. Along with that flexibility, though, comes the greater chance for developing extremely high blood glucoses due having no background insulin as NPH, Ultralente or Lantus (insulin glargine) on board.

If and when your son is ready for a pump, I bet he will let you and his diabetes team know.

LSF

[Editor’s comment: See Is pumping for you?.

SS]