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?
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.