We are considering an insulin pump for my six year old son, and his pediatric endocrinologist is receptive to the idea. He gave us some infusion sets to practice with when we feel our son is ready to try them. I want this to be as stress free of a process as possible for our son so I requested a prescription for Elma cream, but the diabetes educator said that very few families actually use this and that we should try using ice to numb the area before inserting the needle. It seems to me that this would not be as effective. What is your opinion on this matter? Are there long term effects of the Elma cream that I should be concerned about? Are other over-the-counter creams, such as ElaMax, as effective?

I was also interested in trying one of the infusion injectors, but the educator said that these are painful for small children such as my son who do not have a lot of fat to insert them in to. What is your opinion on this? Are they typically more painful than a regular type infusion set?

I have found that the ElaMax cream (over-the-counter) is more effective, easier to apply and quicker to work than the Emla cream. I know of no long term effects from using it every three days. However, in the pediatric population I’ve had the opportunity to work with, most all of the children and young adults do not seem to have a need for either of these creams, but they do prefer to use the auto-inserters for their infusion set changes. The most popular of the infusion sets is the Quick-Set that works with the Quick-Serter. The auto-inserters have the advantage of being able to inject the cannulas (catheter) into the subcutaneous fat at a consistent depth each time one is placed and make the insertion relatively pain-free.

DP
Additional comments from Dr. David Schwartz:

You are followed by a pediatric endocrinologist who is facilitating the transition to a pump; you have a diabetes educator who is giving you advice, but you do not seem trust the advice. There something wrong with this picture in my mind. Are you really ready for a pump?

I think you are getting good advice from your educator. Many children find that the extra step of placing the topical anesthetic to be more of a hassle and are willing to put up with some brief discomfort given the other benefits of pumping. For those who have a bit of “jelly roll” at the insertion site, the spring loaded insertion devices may be beneficial, but I find the thinner folks are more uncomfortable with it. If there is something needed to take the edge off the insertion, a little ice to numb often works well (I have had one family who preferred spraying a spritz of ethyl chloride to the spot; ethyl chloride is the numbing spray that athletic trainers often put on an injury; they preferred that to topical creams such as EMLA.) But EMLA does work in those who need more of a block. It is currently off the market. Over-the-counter ElaMax works also, but I’d suggest doing a few insertions as advised by your team before graduating to other substances.

DS
Additional comments from Dr. Stuart Brink:

Most folks who use pumps figure out how to get the insertions to work without pain medications. ELA Max works quite well as does ethyl chloride spray for “freezing/numbing” the small area used. We use both in the office for blood testing for anyone worried about the discomfort. Nobody seems to know when and if EMLA will return.

SB
Additional comments from Shirley Goodman, diabetes nurse specialist:

I appreciate the time and attention you are spending in planning for the transition of your child to the pump. It is important that your child feel comfortable with the process of getting the pump started, and the fear of pain with the insertion troubles many children (and adults for that matter).

Each practice is different, but we commonly offer the children and families various options for starting up their pump. Until EMLA was temporarily taken off the market this fall, many of the children in our practice used it prior to insertion. We also have had families successfully use Ela-Max. Ice is also offered as an option, especially if you need to get the pump started faster than the other products allow. Some of the children who start off using EMLA or Ela-Max discontinue its use over time.

All of the children your son’s age I have worked with have used catheters like the silhouette. We offer the inserter or to do it by hand. If the family does choose to use the inserter, we also train them on hand insertion for the day when the inserter is ‘lost’.

SG

[Editor’s comment: See Related Products in our pump section.

SS]

[Editor’s comment: Please note: EMLA Cream to be Taken Off the Market in the United States.

WWQ]