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Question:

From Needles, California, USA:

Is an insulin pump really good to have for a child?

Answer:

The use of the pump in children is somewhat controversial. Many physicians are concerned that most young children are not capable of assuming the responsibility of managing the pump. On the other hand, there are many children who have successfully used the pump and feel that they have better control and more flexibility.

I think it is important to realize that the pump does not guarantee "perfect control". In fact, in the DCCT study, there was no difference in control using the pump verses multiple injections. In the DCCT study, however, only Regular insulin was used and not Humalog which may give better control.

Personally, I worry, that the risk of pump failure which can lead rapidly to ketoacidosis if not recognized and properly dealt with, may outweigh the advantages of increased flexibility using the pump. When using the pump, either the user (or a responsible adult in the case of a young child) must be ready 24 hours a day to give insulin injections or reinsert a catheter in case of mechanical problems. In many instances, this creates an impossible burden on the parent or the child.

Another concern of mine is that many children and adolescents are not emotionally prepared to deal with the pressures of wearing a pump. Often, initially they enjoy the novelty of a new mechanical device and the attention they get. Often, however, the novelty wears off and they tire of the responsibility. Many children and adolescents, however, are unable to tell their parents or physicians when the day to responsibility gets too much and may become lax.

On the other hand, there clearly are children and adolescents who prefer the pump and are willing to take on the responsibility in order to have increased control and flexibility.

I think before starting on pump therapy the family should sit down and discuss with their own physician the advantages and disadvantages of pump therapy for them. I also highly recommend, before deciding on pump therapy, both the child and the parents should wear a pump either with normal saline or insulin diluent (infusing an insulin-free solution) for several days to actually experience what it is like to wear the pump before starting with insulin. I think in the case of a young child or adolescent, it should be made clear to the child, that if the burden of the wearing the pump becomes too great, they can go back to shots and not feel guilty.

TGL

[Editor's comment: In an informal survey of the members of the Diabetes Team, when asked:

A) I think all kids should be considered for a pump if their parents think it's a good idea and can run the device for the younger kids

B) I think kids should be old enough to run the pump themselves before it's worth considering

C) I think kids should be old enough to run the pump themselves, and understand the concepts used in changing the pump settings, before it's worth considering

the members of the Diabetes Team split as follows: 1 vote for A, 2 votes for B, and 4 for C (several members didn't vote). I think these results reemphasize Dr. Lebinger's comment that "The use of the pump in children is somewhat controversial," both in the pediatric endocrinology community in general, and amidst our own Diabetes Team. WWQ]

Original posting 23 May 1998
Posted to Insulin Pumps

  
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Last Updated: Tuesday April 06, 2010 15:08:58
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