My 12 year old son was on the pump for almost a year, but went into DKA three times. Most of this was due to his not following his plan of care and doing his boluses. After his last DKA, his diabetes care team took him off the pump. His blood sugars were all over the place. My husband was adamant about getting him back on the pump. We finally convinced his CRNP to put him back on the pump, even though my son really doesn’t want to. He is currently on Lantus at bedtime and NovoLog for meals and highs. His numbers have improved greatly. Should we consider letting him stay on the current regimen or continue on with the pump? He will be starting middle school in September which will be a big change of routine for him. This was another reason for wanting him on the pump.

An insulin pump, obviously, is not an artificial pancreas. It is simply another method of giving insulin. The pump provides a “constant,” albeit adjustable, infusion of rapid-acting insulin. This background, always present insulin, is called the “basal” (or baseline) insulin. Then, one must manually give extra insulin to cover meals. This is called the “bolus” insulin. Furthermore, one should have a way to give even extra insulin to adjust and correct for high glucose levels. This is sometimes is referred to a “correction formula” whereby you have a target glucose and a “sensitivity factor” so as to bring down higher levels. This basal-bolus plan is an attempt to mimic Mother Nature and provide insulin in a more physiologic way. But, giving Lantus insulin (as the basal insulin) and presumably a rapid-acting insulin, such as NovoLog, for the bolus does this also.

I think the most important things you wrote in your letter is that your pre-teen son “doesn’t really want to” go back on the pump and that you believe his control has “improved greatly.”

There certainly are advantages to being on a pump. But, it is a lot of work and, in an adolescent’s mind, wearing a pump might be as if he were flashing a giant neon sign” “HEY! I’VE GOT DIABETES AND I’M DIFFERENT!” I have many patients who have gone on and off (and some back on) their insulin pumps.

I’m willing to bet that he doesn’t display his medical identification, either.

Talk to your son about his reservations about the pump, but I think you know the answer for now: Stay on the Lantus and NovoLog.

If it ain’t (too) broke…..

DS