Updated August 31, 2006

To Pump, or Not to Pump?

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

Is your child a pump candidate?
Starting an insulin pump is a big project that requires time, commitment, and learning new skills. Here are some things to think about if you are wondering whether your child would be a good pump candidate and if now is a good time to start pump therapy. One thing you may not need to worry about is age: Researchers have found that children as young as toddlers can do well on the pump.

Talk to your child. First of all, make sure that your child is interested in using a pump. Your child is the person who will be wearing it all of the time, so make sure that your child is interested in pump therapy.

Assess your child’s current diabetes management. If you are having trouble with your child’s current diabetes treatment plan, you may want to hold off on starting a pump, because pump management can be more complex than injection therapy. For example, if you are not presently using carbohydrate counting, if you or your child forgets to check his blood glucose levels regularly, or if your child misses insulin injections on a regular basis, you and your child may not be ready for the pump.

Learn more about pumps. Both you and your child should talk to your child’s health-care team about the pump and, if possible, talk to other families who have a child using a pump. It is important to discuss the pros and the cons of pump therapy and become educated about how the pump works and what is involved in maintaining optimal pump therapy.

Examine your expectations. A lot of people think that using a pump will automatically bring about better blood glucose control, but this is not the case. Some people think that the pump is automatic and gives insulin according to the body’s needs, but it does not. So-called closed-loop systems, which both sense blood glucose level and deliver insulin, are not yet available. The current pumps only provide insulin as programmed by the user. Although some people eventually achieve better blood glucose control with a pump, there is usually an initial adjustment period after starting it, so you may not see the improved blood glucose results you are hoping for immediately. Even though the newer insulin pumps have software to help calculate bolus doses and keep track of how much insulin has been delivered over the course of the day, you still need to be the “brain” for the pump. The pump is not a cure for diabetes; it is just a different method of delivering insulin.

Think about timing. During the pump initiation phase, it is necessary to check blood glucose levels several times a day and also during the night. Given these requirements, you will want to give some careful thought to when to start the pump. Your child may not want to start the pump during final exams, before a major trip, right before he is leaving to go to sleep-away camp, or right before he leaves for college for the first time. Parents may want to avoid starting the pump during their busiest work time of the year or if they are expecting another child. Some families choose to start the pump in the summer or during a school vacation. Pump initiation may also depend on the availability of appointments with your child’s health-care team members.

Make sure there is parental support. When a child starts a pump, both parents should be interested in the pump, not just one parent or the child and one parent. In addition, all adult caregivers should be willing to learn to program the pump and to count carbohydrates, regardless of the child’s age.

Plan ahead for day care or school. Before ordering a pump, it is good to figure out who will be in charge of the pump at your child’s day care, school, or after-school program and whether this person (or persons) is willing to learn how to give a bolus dose and assist with carbohydrate counting.

Discuss body image concerns and privacy. Your child or teen should think about what it will be like being connected to the pump all of the time. Will it bother your child to be connected to the pump during the day and while he is sleeping? Where will he connect the infusion site? Where will he wear the pump? Will it bother your child to have to disconnect the pump for sports? Will it bother your child to answer his peers’ questions about the pump, if and when the pump is visible?

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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