Updated August 31, 2006

To Pump, or Not to Pump?

by Deborah Butler, M.S.W., L.I.C.S.W.

Kids can also sleep late on the weekends if they wish, because they do not have to worry about taking a morning insulin shot or eating to avoid hypoglycemia. The pump is supplying a continuous dose of insulin at a preprogrammed rate that should keep blood glucose levels in target range.

Another advantage to using a pump is that dose sizes are extremely precise. Insulin doses can be fine-tuned to hundredths of a unit with a pump, something that would be impossible to do with a syringe. This precision can be particularly helpful in young children, who often need very small doses of insulin.

As mentioned earlier, pumps allow more than one basal rate to be programmed, so if your child’s blood glucose level tends to run high during a certain time of the day or night, the basal rate can be increased during that specific time period. Conversely, the basal rate can also be lowered temporarily to avoid low blood glucose at certain times (such as during or after physical activity).

For all of these reasons, some people experience better blood glucose control and fewer episodes of low blood glucose with an insulin pump. Some pump users also say that they feel more comfortable administering insulin in public with a pump, because they only need to press a button to receive insulin, rather than having to draw up and inject insulin with a syringe or use an insulin pen.

Challenges of pump therapy
Insulin pump use also comes with some challenges. One of those challenges involves body image concerns. Some people do not like the idea of being tethered to the pump via tubing 24 hours a day, and they do not want to worry about where to wear the pump on their clothing. Some people who are more private about their diabetes do not like the visibility of a pump, and they do not like having to explain the pump to others.

Athletes who play contact sports generally disconnect the pump while playing, then reconnect afterward. Some find the disconnection and reconnection a bother or a worry. In addition, an insulin pump can only be disconnected for up to about 1 to 1 1/2 hours, so if a game or practice lasts longer than that, your child may need to reconnect to his pump in the middle of the activity to infuse some insulin.

Inserting an infusion set can cause discomfort and arouse anxiety in some children and teens. Another concern is the risk of skin infections that can occur at the infusion site.

If a pump malfunctions, there is a more immediate risk of diabetic ketoacidosis, a serious condition characterized by very high blood glucose levels, because there is not enough insulin in your child’s system. The pump should sound an alarm if the pump malfunctions or if there is a kink in the tubing, but it may not sound if the tubing is not completely blocked. Frequent blood glucose monitoring is necessary with pump use to identify such problems as soon as possible in the event that the pump alarm does not sound. The possibility of a pump malfunction, such as a kinked catheter, while a child is sleeping is particularly worrisome to some parents.

Some people also worry about the pump delivering too much insulin, but this is a highly unusual problem since the pump possesses multiple safety checks to ensure that this will not occur.

Setting up basal rates and bolus doses takes time, effort, and extra blood glucose monitoring. Some diabetes care providers ask pump users to fast for three to four hours at a time to help determine basal doses, and some recommend blood glucose monitoring before and after meals to check whether bolus doses are set correctly. It may take a few weeks to a few months to figure out the correct basal rates and bolus doses and feel more comfortable with the dosing. And because insulin requirements change for growing children, it may be necessary to repeat the whole process periodically.

Another challenge of pump use is the expense. An insulin pump and pump supplies can be more expensive than injections, so if you do not have adequate health insurance coverage, you may want to consider the additional costs associated with pump use before purchasing one. Health insurance generally reimburses 80% of the cost of a pump under durable medical benefits, but this varies, depending on the policy. If you are having trouble getting insurance coverage for a pump, a pump company representative may be willing to talk to your insurance company directly on your behalf.

Also in this article:
Before You Get a Pump…

Deborah Butler is a clinical social worker in the Pediatric and Adolescent Unit at the Joslin Diabetes Center in Boston, Massachusetts. She leads support groups for family members of people with diabetes and moderates Web site discussion boards for teens with diabetes and their families.

This column is edited by Jean Betschart Roemer, a Pediatric Nurse Practitioner at the Children’s Hospital of Pittsburgh and the author of Type 2 Diabetes in Teens: Secrets for Success, which is available through www.learningdiabetes.com.

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