April 20, 2004
Honeymoon, Insulin Pumps
Question from Westchester County, New York, USA:
My son was diagnosed with type 1 in February of this year. Because of our compulsiveness with checking blood glucoses and controlling his diet, our endocrinologist is already recommending we go on the pump. I had read and was told at support groups that we should wait at least a year before considering the pump. However, the benefits seem so encouraging that I think we would like to start the process now. Another thing, we are most definitely in the honeymoon phase with minimal dosages of insulin being currently injected. Should we wait till the honeymoon is over to go on the pump, even though that could be years?
The optimal time to consider continuous subcutaneous insulin infusion (CSII) via a pump is unknown. It may be a matter of preference and style on the part of your diabetes specialist and your and your child’s comfort level. My thoughts are as follows:
Before you start pumping, I think you should already be dosing insulin in a basal-bolus similar method. Our data from the University of South Carolina (not yet in published form but presented at regional and national meetings) indicate that at least for the first of pumping, those patients who went from rather fixed-split dosing of intermediate and short-acting insulins did NOT do as well on pumps as the patients who first went on a basal-bolus plan with long-lasting insulins and then adding rapid-acting insulins based on food intake. Not only did these former “multiple daily injection” patients do better with the A1c, but in addition, they are already used to a shot regimen should the pump have a problem, the battery gives out, the pump is dropped in the toilet or lake, all of which and more can and do happen.
While the honeymoon is terrific and allows relative ease of diabetes control, it also can be intoxicatingly deceptive and perhaps “falsely” reassuring. It’s so easy to keep the glucose levels in general good control that when the honeymoon ends. I’ve seen families get frustrated about “something having changed! We’re not doing anything different!” Exactly! They are NOT doing anything different; sloppy habits have developed and the DIABETES has changed.
So, I do generally prefer for patients to undergo multiple daily injections with a basal-bolus regimen for at least six months or longer before pumping and I think pumping after about a year or so since diagnosis is not unheard of or out of the question. But so much does depend on your and your child’s skills. Is he ready to take on this responsibility and be willing to give a bolus of insulin EVERY time he routinely eats? Is he doing that at school now? Will he like being attached to a device all the time? How might that affect his usual activities such as sports? You may want to review our links to “Is Pumping for You?” and Insulin Pump Therapy.