My six year old daughter has had type 1 diabetes for four years, and we are planning and very anxious to start her on the insulin pump soon. We will have to stay in the hospital for two days when she starts on it, and we were hoping that we could do this during a long vacation so we could get the hang of the pump before she goes off to school all day, but it turns out the hospital has no dates then.

Do you think it would be okay for my daughter to go to school with a brand new insulin pump? The school personnel are aware that the pump is coming, and I will give them instructions. I am worried though, since I don’t know what to expect of it and whether the infusion set will be okay, etc. I would plan on doing this during a light week for me so I can be on hand easily if her teachers call. What is your opinion on this?

Some centers do not hospitalize the new insulin pump starts at all. Families spend half a day at the doctor’s office (or wherever the pump is started) and then off they go to their usual routines. Certainly close follow up with your diabetes specialist must be maintained after the pump is started.

That said, I prefer to hospitalize my pump starts, at least overnight to follow the glucose levels and to ascertain that the calculated basal rates and boluses are not excessive. Going back to school the next day is terrific since you need to really fine a tune the insulin dose when your daughter is in her “routine.” In order to minimize lost school days, my families often prefer a Friday admission, home on Saturday and the weekend is theirs before school on Monday.

DS
Additional comments from Dr. Stuart Brink:

You should ask these questions to your daughter’s diabetes team. We don’t put kids in the hospital for pump starts but do them in the office with daily visits for a few days and then space the visits out to weekly for a few weeks. The school questions depends upon the staff at school and how much they already know about diabetes and how much they are willing to learn. There are some excellent materials for school folks.

SB
Additional comments from Shirley Goodman, diabetes nurse specialist:

Transitioning to pump is a time of change and challenge. I think it’s most important that you feel comfortable with the pump, its operation, and the safety net you have in place while your child is in someone else’s care.

Is it possible for someone from your daughter’s school to attend a teaching session with you when she starts on the pump? Is it possible that a pump trainer from the pump company could come to the school or school district and inservice the school on pumps? This would help to take some of the education needs off your shoulders and give the school the information from someone more comfortable with the pump than you are likely to be.

Certainly, you will need to have a plan in place as to how to handle insulin dosing for food, snacks, pump problem days, and be available for your daughter’s school to help them when problems arise.

SG