From Dublin, Ohio, USA:
My eight year old son was diagnosed with type 1 at 13 months of age, and his out-of-town endocrinologist wants to put him on a pump which we're all excited about it. The problem is, our endocrinologist's practice is a three-hour drive. We've been to all the "best" doctors in our local area, but diabetes care is poor. We just returned to this endocrinologist and are so glad we did. How do we realistically go on the pump with no local support?
I am concerned that there is no one in your hometown that you feel you can work with on the insulin pump therapy. If you absolutely can not work with the teams in your area, I guess you can probably manage. I hope you do have access to a support group of parents of other kids with pumps in town so you can at least bounce some challenges off them.
If you are going to rely on the team that is three hours away, I think you should have access to them via an 800 number and faxing in blood glucoses on a very regular basis. Who will actually be starting your child on the pump -- someone in the new endocrinologist's office or a pump trainer in your city? Another consideration is if you run into a pump infection, I am not sure you will want to travel back to check that out. If your child was already on pump therapy and you moved to an area where you did not want to transfer care to, that would be different from starting out without any nearby support.
Additional comments from Dr. Linda DiMeglio:My recommendation would be for them to choose a pediatric diabetes center to coordinate your son's care, in your city or at the other endocrinologist location. Long-distance pump care can be done, but it is preferable that families are followed for a while before starting a pump to make sure they're optimizing injection therapy (especially with an eight year old child). You would only need to do clinic visits every three to four months so driving in does not become a huge issue. T he rest is managed by phone -- if the center doesn't have the funding for an 800 number yet, they might use e-mail and return calls to save people money.
[Editor's comment: While this scenario is not ideal, as long as you. the rest of your family, and your son's pediatrician are willing to provide support, I see no reason not to start your son on a pump. It will be essential, as Lois has pointed out, to have clear accessible lines of communication with the out-of-town diabetes team both for you and your son's pediatrician, especially during the first few weeks. I have some suggestions:
- As Lois has said, see if you can find another child with pump experience in your area.
- Establish clear communications with the pump team (phone, fax, e-mail, etc.) for both you and your son's pediatrician.
- Have the pump representative give your son's pediatrician a "crash course" to help troubleshoot.
- If possible, spend the first week in the pump teams' town, until doses are fairly stable, and you feel comfortable with insulin to carb ratios, etc.
Original posting 17 Nov 2001
Posted to Insulin Pumps
Last Updated: Tuesday April 06, 2010 15:09:27
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