My eight year old daughter was diagnosed with type 1 diabetes at the age of five. She currently receives insulin shots. Her daily schedule includes five or six shots per day. We count carbohydrates with her and her insulin dosage is one unit of Humalog per 20 grams of carbohydrates, along with 10 units of Lantus at bedtime. Her last A1c was at 7.2.. Before that, it was 6.4. Why is she not eligible for a pump? Her pediatric endocrinologist said something about “tweaking” her insulin regimen in order to make it work with a pump was too complicated. I just don’t understand. What does this mean? Why can’t she get a pump?

There are no hard and fast rules as to whom is eligible or not eligible for a pump. Nor are there any good predictors of who will be “successful” in utilizing a pump.

In our center, we use the following set: the patient must have been followed by us for more than one year, parent/patient must be able to carbohydrate/insulin count and use corrective doses, and that families must be able to understand the potential drawbacks of pump therapy (dependence on short acting insulin, potential for issues with infusion sets).

In an eight year old child, there is an additional concern of who will help her manage the pump when she is not in your care. How many caretakers does she have? Is the school ready/familiar/comfortable with pump issues? Who will calculate her doses? There is also the issue as to whether she wants to wear a pump 24/7.

I also would have realistic expectations of pump therapy. In children who are in good glycemic control prior to pump, the pump will increase their flexibility and decrease the need for shots, but not necessarily improve the hemoglobin A1c or frequency of hypoglycemia.

I would clarify with your endocrinologist what reservations he/she has about pumps for your child and for children in your daughter’s age group. If he/she does not have experience with young pumpers, you may be able to find a center near home that does.

LAD