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Question:

From Apple Valley, Minnesota, USA:

My 9 year old daughter, diagnosed 9 months ago, little or no honeymoon, is independent and motivated, wants a pump and I support her. Initially our diabetes team was cautious, but after seeing her numbers, monitoring 4-6 times a day faithfully, meal plan dedication, three or four shots a day, and still wide variation in blood sugars (35-600+), A1c 8.6 (11.9 at diagnosis), the team is now encouraging pump. Question: Should we use Regular or Humalog with a pump? Our team is new to kids with pumps, and they seem uncomfortable with Humalog. Is there an advantage to either?

Answer:

Recent studies are starting to show that Humalog may give slightly better control in the pump than Regular. Since Humalog works faster and lasts a shorter time than Regular, there is less delay in seeing its effect when used either as a bolus to match food or to correct a high blood sugar. If the Humalog works too quickly before meals, the mealtime bolus can be given over a longer period by using the "Square Wave" bolus feature available on the Minimed 507 pump.

The major disadvantage using Humalog is that if there is pump malfunction (or the catheter comes out which will not trigger an alarm and may go unnoticed by a young child), the blood sugars may go up very quickly and ketoacidosis can occur in a shorter period of time than when using Regular. Also, when using Humalog, the pump cannot be disconnected for as long a time as when using Regular for contact sports or if the child won't wear it swimming and you may have to give supplemental injections while disconnected.

One way to get many of the advantages of using Humalog but decrease the chance of problems is to give a small amount of intermediate or long acting insulin at bedtime (or even twice a day) to provide part of the "basal" requirements and use the pump to provide the remainder of the basal requirements and all of the boluses. You will, however, lose some of the flexibility of adjusting the basal rate. This approach is used frequently in pregnancy where pump failure during sleep could be fatal to a developing fetus. I have also heard of this approach being used in non-pregnant individuals. Of course, many children (and adults) may not want to both wear the pump and give subcutaneous injections.

I suggest you sit down with your child's team and decide which insulin you think will work the best for your child. You can always switch from one insulin to another if you want, though you will probably need to readjust the doses of insulin.

TGL

Original posting 7 Jun 1998
Posted to Insulin Pumps

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