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Question:

From Iowa, USA:

I have a five and a half year old daughter who has had Type 1 for three years. We work very hard in keeping her under excellent control. We check her blood sugar five to six times per day. She takes NPH and Regular insulin twice per day. Over the last three years her glycosylated hemoglobins have ranged from 6.3 to a high of 8.3. Her last one was 8.1 despite having mononucleosis. She has minor lows four times per week. We have never used glucagon and she has not been in the hospital since her initial diagnosis. I have heard great things about the pump being used in children. Do you think she would be a candidate? I am a family physician and my wife stays home with our children.

Answer:

Personally, I have no experience in the use of the pump in children this age, though the pump has been used successfully in this age. Personally, I think it is too large a responsibility for a child this age though there are both parents and physicians who disagree with me.

The pump is not an artificial pancreas, and it's successful use depends on careful matching of the insulin to food and exercise. A young child may dislodge the catheter while away from home and be unaware of it (no alarm will go off if the catheter comes out, only if it is blocked) and ketoacidosis can develop rapidly, especially if Humalog is used.

Even if your daughter does go to the pump or multiple daily injections, it is unrealistic to expect normal hemoglobin A1C's in a growing child (even in the DCCT study, only 4% of the adults were able to achieve high normal HgbA1C's using the pump or multiple injections. The adolescents couldn't even do that well).

I would suggest discussing with your daughter's physician the advantages and disadvantages of pump therapy in your child.

TGL

[Editor's comment: I suggest that you visit the Pump Users chat room and chat with other parents of children who use pumps. JSH]

Original posting 5 Jun 1998
Posted to Insulin Pumps

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