Updated August 31, 2006

To Pump, or Not to Pump?

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

Prevent weight gain. Some people who start using an insulin pump report weight gain. The main reason for this seems to be the flexibility the pump allows in terms of eating. Some people starting the pump think that they can eat whenever they want and whatever they want, because they just need to “push a button” every time they eat. However, regardless of whether a person uses an insulin pump, eating more calories than are burned will cause weight gain.

Update your settings. Often, pump users neglect to make necessary insulin adjustments with growth, activity changes, etc., because the pump has become so automatic and appears to “self-correct.” Remember that a pump is not smart, so the person (and family) using the pump needs to be. The basal doses and the calculations needed for carbohydrate intake and blood glucose correction doses need to be changed according to the child’s growth, phase of pubertal development, sports schedule, etc. It is important to continue frequent follow-up with your child’s health-care team to make these changes in a timely manner.

Worsening control
If your child’s blood glucose control seems to be deteriorating with pump use, there are additional strategies that you can try to help improve the situation.

Increase parental involvement. Some preteens and teenagers take over a lot of their diabetes management tasks when they go on the pump, and they can get burned out or overwhelmed with this responsibility. With increased family involvement, however, blood glucose control may improve.

Talk to your health-care team. Tell your health-care team what you and your child are struggling with in terms of the pump and overall diabetes management. For example, if your child has gained weight, is having trouble with site infections, or forgets to take bolus doses, talk about these issues. Your child’s health-care team can only help find solutions to these problems if they know about them.

Consider taking a pump “vacation.” Some people who normally use an insulin pump stop using it and return to injections for a while when they feel burned out from wearing or using the pump. A pump vacation can vary in time. For example, your child may just need a few days, because he is going on a beach vacation and does not want to wear his pump at the beach while wearing a bathing suit. Or your child’s pump vacation could be for a few months, during the summer or during an intensive sports season.

Before your child takes a pump vacation, discuss these plans with your child’s health-care team and review other insulin therapy options. Remember that a longer-acting insulin has to be added to your child’s insulin plan if he stops using his pump.

Consider switching back to injections permanently. Some people who are struggling on pump therapy decide to make a permanent transition back to injections. The main reasons for terminating pump therapy include burnout, worsening blood glucose control (because of forgetting to bolus, for example), infusion site problems, weight gain, or body image concerns.

Finding what’s right for you
The insulin pump is an exciting piece of technology, but it’s not for everyone. If you are wondering whether a pump would be a good idea for your child, discuss this with both your child and your child’s health-care team. If your child is currently using a pump and is having difficulty with it, you and your child should discuss this, too, with your child’s health-care team. What’s important is that you find a method that works for you.

For a list of things to things to think about when considering insulin pumps, see "Before You Get a Pump...". For more information on insulin pumps, see "For Further Reading."

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