Insulin pumps can be great tools for managing diabetes in people of all ages, including children, teens, and even infants. Because pumps constantly deliver a low level of “background” insulin, and larger doses need only be taken before meals (or to “correct” unexpected high blood glucose), they can allow a user greater flexibility with respect to meal schedules and food choices than conventional insulin injections. Pumps also deliver more precise amounts of insulin than can be measured with a syringe. And modern pump technology tracks how much insulin has been delivered, when it was delivered, and how much of it is still active in the body, so there’s less of a chance of taking too much and ending up with low blood glucose (hypoglycemia). (Click here for a list of insulin pumps that are currently on the market.)
Clearly, all of these characteristics can help a person achieve optimal blood glucose control. However, an insulin pump is only a tool: It can’t think for itself, and it is therefore only as “smart” as the person who is using it. In the hands of a motivated, diligent user, a pump can be a very helpful and precise tool. In the hands of a user who expects the pump to do the work for him, however, it may help to control blood glucose levels no better than any other method of insulin delivery. Even with a pump, it’s still necessary to count the carbohydrates in meals and snacks, match insulin doses to the foods being eaten, monitor blood glucose levels frequently, and make adjustments to meals, exercise, or insulin doses based on monitoring results.
Everyone who uses a pump should receive comprehensive training on how to use it. But no matter how much training you receive or how many instruction manuals you read, some issues don’t become apparent until a person is actually using a pump. Some pump-related issues seem to be more common among children and teens, possibly because of their active lifestyles or their developmental stages.
In this article, parents whose kids use pumps, kids who use pumps, and health-care professionals who work with kids who use pumps offer ideas, tips, hints, and advice on common problems and how to avoid them. Your pump trainer and diabetes educator are also great resources to call on when problems arise with pump therapy.
“Bad” sites
The most common mechanical problem that occurs with pump use is a bad infusion site. The infusion site is where the very thin Teflon or stainless steel cannula that delivers the insulin to the tissue just under the skin is inserted. Some cannulas are inserted manually, while others are inserted with a spring-loaded insertion device.
In most cases, a plastic connector joins the cannula to a length of thin plastic tubing, which carries insulin from the pump to the cannula. The connector is generally mounted on an adhesive patch that is stuck to the skin at the insertion site to help keep the cannula in place.
When a site goes “bad,” insulin is not being delivered properly at the infusion site. This can happen if the cannula becomes kinked or crumpled upon insertion or if the tip of the cannula is pressed against muscle or other tissue that does not absorb insulin well. Sometimes it’s not clear what the cause of the problem is, but signs that there is a problem include suddenly higher blood glucose or a gradual but steady rise in blood glucose.
