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Insulin Pump Therapy for Kids

by Jo Ann Ahern, APRN, MSN, CDE

There’s no doubt that interest in insulin pumps is up among people with diabetes. In fact, the most commonly asked question of the staff at the Yale Children’s Diabetes Program in New Haven, Connecticut, is, “Am I a candidate for the pump?” or “Is my child a candidate for the pump?” In many cases, the answer is yes.

Let’s have a look at what makes a child a good candidate for a pump and what’s involved in getting started using one. As you read, keep in mind that this article describes primarily how the Yale Children’s Diabetes Program operates. As in all aspects of diabetes care, there are many “right” ways of doing things, and the diabetes center in your area may do things differently. If you are interested in any of the methods or products mentioned in this article, please check with your health-care team before making changes in your child’s diabetes-care routine.

Who’s a pump candidate?
The children who are most likely to be offered a pump at Yale are those who are working very hard to maintain normal blood glucose levels, those who are not meeting goals, those who ask about pump treatment and how it might help them, and those whose episodes of hypoglycemia or high blood glucose are affecting their school work, sports performance, and normal, day-to-day living.

However, pump treatment will succeed only if both child and parents are motivated and have reasonable expectations of what a pump can and can’t achieve. They must understand that a pump is only as good as the person operating it. In addition, parents need to be reliable, and a child must be willing to check his blood glucose level at least four times a day. In fact, a child or teen wouldn’t be considered for pump treatment at the Yale Program if this minimum requirement were not already being met.

Since many children are afraid of any change, a little persuasion is sometimes in order for a child to try a pump. It’s important to let a child know that pump treatment can help him feel better, have more normal blood glucose levels, perform better in school and sports, and have fewer episodes of hypoglycemia. He will also have much more flexibility in terms of mealtimes and food choices. And, if more normal blood glucose levels are achieved, the incidence of long-term complications of diabetes will be greatly decreased or eliminated.

Youth no object
The age of a child is a consideration for pump candidacy, but no age rules out the possibility of using a pump. I recently put Maggie, age 18 months, on an insulin pump. She was having difficulty with both high blood glucose and hypoglycemia at all times of day and night. Her blood glucose level would frequently drop overnight, even with no insulin in the evening. Her mother was checking her blood glucose levels eight to 10 times a day and was becoming very discouraged. Clearly, it was time to try other treatment options.

At the time of writing, there are 36 children under the age of seven on pump therapy in the Yale Program. Their reasons for starting on pump therapy have varied. Sometimes a child in this age group is doing well with insulin shots, but the parents would like the flexibility that the pump offers. Many parents would like to make mealtimes more pleasant and to not have arguments over food. (Even at their best, children in this age group tend to be finicky eaters.) They would also like to smooth out the blood glucose swings that are so common in a young child.

Once a child is three or four, he is able to deliver an insulin bolus (the dose taken before meals) himself, but he needs someone to verify the amount before activating it. When a child younger than seven is started on the pump, we usually use the block feature on the particular pump we use, which keeps the child from activating the buttons on his own. This feature is usually used only for the first week or so; after that, the novelty usually wears off, and the child doesn’t tend to play with his pump.

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