Q: We're thinking about switching to a pump for our son. What factors should we consider in making the choice between insulin injections and insulin pump therapy?
A: Use of a pump to deliver insulin is a popular choice among many kids and adults with type 1 diabetes -- and for many good reasons. As most "pumpers" will tell you, the major advantage of a pump is that it replaces the need for daily insulin injections. Pumps can also offer finer control over insulin dosing (some models adjust to literally hundreds of settings), require fewer supplies when out and about, and may do a better job at keeping blood sugar levels on an even keel, especially during those tricky overnight hours.
All this sounds great, but when considering whether a pump is right for your son, one of the first factors to consider is time. How long has it been since your son's diagnosis? In general, pump use typically isn't considered until a few months after diagnosis, mostly because learning about type 1 care is overwhelming all on its own without the added burden of learning to use a new piece of technology. Waiting two or three months gives your child's blood sugar levels the chance to stabilize and for you to feel truly expert in your ability to count carbohydrates, calculate insulin doses, and deal with highs and lows.
Another key factor is motivation. Are you ready to commit to the extensive education required to correctly operate a pump -- and is your child ready and willing to wear one 24/7? To get a better idea of what pump use entails, have a conversation with your child's endocrinologist to become familiar with the actions and functions of the pump and how this might match your child's needs. An insulin pump does not perform blood sugar testing or make independent decisions in treating diabetes. It's an insulin delivery device that is programmed by the parent or caregiver (and the child, once he's old enough) and adjusted as needed for changes in carbohydrate intake, activity, and other variables that affect insulin needs.
Many diabetes centers offer introductory pump classes to help families decide on appropriate insulin therapy. Your endocrinologist will likely want to know: are all caregivers available to participate in pump education? What about the school nurse and other relevant staff members -- are they already trained in pump use or willing to learn? At Children's Medical Center in Dallas, for example, our program has a 1.5 day education program with telephone follow-up. After this initial training, parents and caregivers need to more frequently monitor blood sugar, especially overnight, to make sure the pump is correctly delivering insulin (and in the correct amounts). Does your family have time to devote to this?
Another consideration is financial. Some health insurance policies cover pumps while others do not. Others may offer partial coverage or require co-pays to cover pump costs. Most pump manufacturers offer a try-out period to make sure the style of pump is compatible and comfortable for a child -- think about taking advantage of this before making a financial commitment. Because even the highest quality pumps have the potential to break or malfunction, families will still need to invest in maintaining a supply of syringes and related supplies. Pump users also continue to require glucose testing strips and a glucometer for blood sugar checks.
And last but not least, what does your child think about all this? Many kids (and adults) with type 1 welcome the relative freedom and flexibility of pump use, but there is no one-size-fits-all answer here. Some children adapt quickly to wearing a pump, while others just don't like the process of connecting the pump at the infusion site (typically done with a larger needle than standard syringes). For older kids and teens who play contact sports like football, a pump may just not be practical or safe to wear. Your endocrinologist or diabetes educator can give the specific pros and cons of pump use versus injections for your circumstances. And remember, it's your child who will be wearing the pump, not you -- make your decision accordingly.
--Kathryn Sumpter, M.D., is a pediatric endocrinologist at Children's Medical Center and an assistant professor of pediatrics at the University of Texas Southwestern Medical Center in Dallas.
How Other Parents Deal
"Our school nurse had never used a pump before -- glad I asked! She was more than willing to meet with our diabetes educator for training and can now explain the pump to other school staff members."
--Katherine, mom of Arianne
Disclaimer: The information in these articles is not intended as medical advice. Families should check with their healthcare professionals regarding individual care.
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