Updated August 31, 2006

To Pump, or Not to Pump?

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

Have a professional evaluation. Your child’s health-care team may already have a pump evaluation protocol in place. At the pediatric center at the Joslin Diabetes Center, for example, a pediatric endocrinologist, nurse educator, registered dietitian, and mental health clinician (social worker or psychologist) complete a multidisciplinary pump evaluation. If your child‘s health-care team does not have a formal pump evaluation protocol in place, discuss the issues raised in this article with your child’s health-care team.

In some cases, a health-care team might suggest postponing pump initiation if a family is struggling with the current diabetes treatment plan, if either the child or the parent is not interested in the pump, or if there are other stressors occurring in the family’s life that would interfere with learning the skills necessary for pump therapy.

Once a child has gotten the go-ahead for a pump, many pediatric pump programs start with a saline infusion so that the child and family can practice the pump features while still receiving injected insulin for a brief period of time (a few days to a week). This practice usually follows the decision to purchase the pump, so it is important to review any major concerns beforehand.

Optimizing pump therapy
Once you and your child have decided to go forward with insulin pump therapy, it is important to think about how to maintain optimal pump therapy over time.

Maintain parental involvement. Parental involvement is very important for all children and teens with diabetes, including those who use an insulin pump. Sometimes parents become less involved with diabetes management when their child starts the pump for several reasons: The child may be looking for more independence, the parents may be “burned out” on diabetes management and need a break, the child may learn the computer programming faster than his parents, or it may feel more invasive for parents to help with pump programming because the pump essentially becomes part of the child’s body. However, we know that children and teens benefit enormously from positive family involvement with diabetes pump-related tasks.

Plan ahead. Discuss with your health-care team what you or your child will need to carry around in case a pump-related problem develops, in addition to what you or your child normally needs to carry around (such as a blood glucose meter and sources of carbohydrate to treat low blood glucose). For example, it is a good idea to carry around pump batteries, an infusion set, and a vial of insulin and a syringe or insulin pen. If the pump malfunctions or breaks, your child will need to take insulin by a syringe or insulin pen temporarily until his pump is fixed or replaced.

Maintain realistic expectations. Even after starting pump therapy, it is important to maintain realistic expectations about what the pump can and cannot do for your child. Some people see better blood glucose control in the first three to six months after starting a pump, but over time, blood glucose levels may return to pre-pump levels, or diabetes control may even worsen over time. This deterioration might happen if you and your child are checking his blood glucose levels less often, becoming lax with carbohydrate counting, forgetting to bolus, or disconnecting the pump for extended periods of time without any backup insulin or if overall family involvement has decreased.

Stay consistent. Consistency is very important for optimal pump therapy. It is essential to count carbohydrates and check your child’s blood glucose level every time he eats. The bolus of insulin should be delivered before eating (although toddlers frequently receive bolus doses after eating because of their often erratic eating habits). Some pump users become frustrated managing all of the data and do not always pay attention to the details that are necessary for optimal diabetes control. However, if you or your child is not checking his blood glucose and counting carbohydrates every time he eats, you will not be able to choose the proper bolus dose. Some people have reported that they forget insulin more often on the pump than when they were on injections, so it is easy to get off track. Frequent blood glucose monitoring is also vital on the pump because of the risk of diabetic ketoacidosis if the pump breaks or fails.

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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