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December 21, 2001

Insulin Pumps

Question from North Brunswick, New Jersey, USA:

My two year old son was diagnosed with diabetes two weeks ago, and a physician said he was starting pumps on children this young with good results. Do you have any experience in using pumps with children this young?

Answer:

There are a few centers in the country (including our own) who are now starting very young children on insulin pumps. There are, however, no conclusive data yet that this therapy is either safe or effective in very young children or in children so soon after diagnosis, although a few comprehensive studies are in progress.

In order to use a pump effectively in a very young child, you will need extensive training in carbohydrate counting, insulin/carbohydrate ratios, and corrective dosing for high blood sugars. For now, with a very newly diagnosed child, I would recommend getting that sort of training and education. Once you have that in hand, if you’re still interested in pump therapy, check out the data available to date and then (if it appears favorable), I’d recommend searching out a center where they have expertise in using pump therapy in pre-school children. It is important that the physicians and nurses that you are working with have this experience, since your child would need very close follow-up and the patterns of insulin usage are different in preschoolers than in older children and adults on pumps.

Our experience with 28 families to date has been positive overall for very young children on pumps, but we have found that those families who are best prepared going on pump therapy have the best outcome for their child (in terms of ease of use, satisfaction with therapy, and glycemic control). Many families with very young children (especially if they are in a honeymoon period do equally well on flexible insulin injection regimens that incorporate variable dosing to accommodate erratic eating and activity patterns.

LAD