From Stone Mountain, Georgia, USA:
I am 12 years old, and I am interested in an insulin pump because my blood glucoses have been 200-300+ at breakfast in the morning, and 150-250 for dinner. (My range is 80-180.) My parents don't know what to do because if we change anything, my glucose is about 30-40 in the middle of the night, and for dinner, if I reduce my lunch, I have to get snacks about every two hours. What should we do?
It's not an easy task to answer your question specifically by e-mail. First of all, it would be important to know your daily insulin doses and see if you're already on a proper intensified regimen (for example, Regular before meals, eventually added with NPH at breakfast and/or lunch, plus Regular before supper and NPH at bedtime as well as the correct timing of your insulin injection) that could assure you a better fasting blood sugar avoiding lows during the first half of the night.
Only if such a regimen, properly applied, doesn't work, then I'd advise the pump to an adolescent: in fact it takes a lot of motivation and of education, and quite a lot of coaching from your diabetes team, to learn the new and complex program associated with an insulin pump.
I think that if you and your family have already achieved the most important factors (education and motivation), you should be able to control your daily blood sugar shifts on subcutaneous insulin therapy without the need of a pump. And if not, you should now concentrate on them before any new device such as a pump is considered.
In any case, you'd better discuss how to find the best way to treat your diabetes with your diabetes team.
Additional comments from Dr. Quick:Dr. Songini doesn't sound too excited about using a pump in your situation. Neither do I. Starting an insulin pump is a very complicated decision for anyone to make, let alone a 12 year old, and the factors that I consider important before anyone makes a final decision include much more than just correcting a single problem with blood sugar control. Other factors include the level of your desire to "take control" of your diabetes, your need for more flexibility in insulin delivery to match a variable lifestyle, your willingness to live with a device 24 hours a day, your willingness to check at least 4 blood sugars daily, and much, much more: for instance, do you have a doctor and diabetes team who are familiar with using pumps in young adolescents? Who's going to pay for the pump? What do your parents think of pumps? Are you an independent-minded individual who's willing to experiment? Do you like mechanical gadgets?
Basically, there are many possible ways to give insulin by shots to deal with your present problem, and until they are all tried, it's difficult to visualize that starting an insulin pump would be any easier. A pump is appropriate part of diabetes therapy for some kids your age, but only after long consideration of all the factors involved.
Additional Comments from Ellen H. Ullman, Advocate for children who have diabetes and their parents, and mother of a child with diabetes:First I want to praise you for realizing that your current control of blood sugar feels inadequate and that you want to be proactive in making a change for the better for both your physical well being and your emotional well being.
Any person who is considering a pump, either for him/herself or for one's child, must gain knowledge about pumps and pump therapy. It is equally important to find a physician who is experienced with pumps for children, or who enthusiastically is willing to learn right alongside his/her patient. I would also encourage you to find a local pump support group even if it is one primarily or completely comprised of adults. You must be prepared to test your blood sugar frequently as rapid rising blood sugars can occur when there is a malfunction.
My son's doctor, as part of her protocol, requires at least one parent to wear a loaner pump with saline for at least 24-36 hours. She then requires the potential pump patient to wear the loaner for a weekend. This is a good exercise in finding out what it feels like to be attached to a pump 24 hours a day and only after this experience will she give the go ahead for pump therapy. She also provides extensive training in pump management, dietary intake, carb counting, record keeping, bolus and basal adjustments, managing lows and highs, trouble shooting etc. By the time the patient is started on insulin in the pump, the family is 100% prepared to manage every aspect of the pump and the patient is then admitted to the hospital to do it all under scrutiny of the MD, CDE, RD. We brought all of our own supplies to the hospital to reduce incurred costs.
Please refer to the following websites to gain more knowledge about pump therapy and know that you do in fact have an alternative to multiple daily injections. Be assured that pumping is an ever changing process and one must be dedicated to achieve the desired results. It can often be frustrating as it is still diabetes, but it's wonderful when you stick to it and see the results of your efforts.
- Diabetes Mall: Get a hold of the book Pumping Insulin by John Walsh. Comprehensive and a bit daunting in scope but really lets you know what pumping is all about. Also at his site is an important article about Pumping Humalog.
- DiabeteSource Articles: Read this article and copy it for anyone you think would benefit. It's the third article at this URL so scroll down: "Who? When? Why? How? Where?... Children & The Pump" by Jo Ann Ahern, APRN, MSN, CDE Coordinator of the Yale Program for Children with Diabetes. From this site:
Questions I often encounter: Who is the right candidate for the insulin pump? How old should he/she be? These questions are always difficult to answer. Past history (DCCT) indicates there is no way to predict who will do well on a pump. Before initiating pump therapy, it is important to know the child well enough to be confident they will have the necessary support and motivation to be a successful pump user.
- Disetronic: Order all free materials and videos about the Disetronic Pump. The Spring '98 News features "Kids and Pumps.". They also have a Pump Chat one night per week at their site: Monday nights at 9:00 EST.
- MiniMed: Order all free materials and videos about the Minimed pump. Explore their website as well and request their Teens Pumping It Up book.
- Unique Insulin Pump Accessories: Order a catalog or look at their on-line catalog today. These women provide wonderful ways to wear the pump comfortably and discreetly.
- Insulin Pumpers Homepage: This is the Insulin Pumpers Homepage, which has a wealth of information. Sign up for a mailing list or message board access. All your answers can be obtained here from other pumpersor parents of pumpers. Be sure to check out the kids stories here too. This is a tremendous resource. Lilly's story is most compelling!
- Insulin Pumps and HMOs: Michelle Spaulding's post about how she fought an HMO about the pump and won.
- KidsRPumping: Lots of stories of kids pumping and one pediatric endocrinologist's view of pumping for kids.
- Children with Diabetes Chat Rooms: Visit the Pump Users chat room. You'll get lots of direct answers from parents with kids on the pump or adults using and considering the pump. If there's no one in the Pumper's Chat room, try the Parents' Chat. The Pump Users room is new and is just taking off. These chat rooms are open 24 hours a day. If someone isn't there, type in "hello" and soon someone else will show up.
- Melissa's Diabetes Chat room is also filled with parents of children with diabetes and adults with diabetes and often pumpers.
- AOL now offers a Monday and Wednesday night Pump Chat at 9:00 p.m. EST. This will only be accessible for AOL Members. But open 24/7 AOL Insulin Pump Chat on Monday, Wednesday and Saturday at 9:00 p.m. In additional, on AOL, there are the message boards at keyword Better Health. Better Health Diabetes Message Board. Check out Kids on the Pump and the Meters/Pumps lists.
Original posting 30 Sep 1998
Additional comment added 11 Oct 1998
Posted to Insulin Pumps
Last Updated: Tuesday April 06, 2010 15:09:00
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