My 15 year old son has been on an insulin pump for six months. He has had diabetes for four years. Until he started on the pump, the highest blood sugar I ever saw was 350 mg/dl [19.4 mmol/L]. His A1cs were 5.7 to 6.2. Since the pump, our lives are upside down with frequent episodes of mild DKA. The pump frequently stops working in school and he comes home sick. They all tell us the pump is better, but it seems more dangerous because you never know if it is working or gets dislodged in school during sports. He also does not like to check his sugar in school and this is contributing to the problem. I am at my wits’ end. What do you advise?

It seems that, unfortunately, you were ill-prepared for one or two of the serious potential pitfalls of pump therapy:

the pump is NOT an artificial pancreas and, despite the verbalized recognition of this by patients and families, sometimes on a more subconscious level, people get more “lax” with their diabetes and do not give the appropriate intensity to carbohydrate counting, meal planning, basal dosing, etc. [I am not saying this is what you have done; rather it is a phenomenon seen.]

without a background of insulin as you did with shots [e.g. NPH or Lantus], if there any significant interruption in the insulin flow (pump failure, kinked tubing, leakage, etc), then DKA can develop very quickly.

Without knowing more details, I strongly urge you to talk to your diabetes team about either potentially switching pumps to another company, but I would favor DISCONTINUING the pump in favor of shots once again.

DS

[Editor’s comment: You may also wish to discuss The Un-Tethered Regimen with your son’s diabetes team.

BH]