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.
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.
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.