School-age kids (7 to 12 years old) are great pump candidates. They tend to be excited about the pump and want to help as much as possible. They also tend to be very successful at keeping their blood glucose level in the normal range most of the time. They can give bolus doses themselves but need some help deciding how much to bolus. They can begin counting carbohydrates and are able to use their insulin-to-carbohydrate ratio, as determined by their health-care provider, to tell how much insulin they require per carbohydrate exchange. (A carbohydrate exchange is approximately 15 grams of carbohydrate.) In general, kids this age are proud to show off the pump to their friends and think it’s quite cool to wear.
Teens are probably the least reliable group to start on the pump. Even though they easily learn how to use it and quickly pick up the mechanics, they are typically preoccupied with many other things, and the pump quickly goes down on the priority list. Teens frequently forget to bolus. They do better on the pump than they do with shots, but they don’t do as well as younger children.
If child and parent agree on the idea of pump treatment, the next step is to explain a little more about what the pump will and will not do. The child and parents are shown an insulin pump and how it works. This provides the opportunity to clear up any misconceptions about what pump treatment entails and to address any fears.
An insulin pump is a cell phone-size device that contains a cartridge filled with fast-acting insulin. Either Regular or lispro (brand name Humalog) can be used. Intermediate-acting and long-acting insulins are never used in a pump. Furthermore, since the pump delivers insulin continually, intermediate-acting and long-acting insulins are no longer needed in the insulin regimen.
In addition to the insulin cartridge, the pump also contains a tiny computer, which allows it to be programmed, a motor, which pushes insulin out of the cartridge and into the body, and a battery, which must be changed periodically. The pump is worn outside the body and is generally clipped to a belt or carried in a pocket or special pump pouch.
Attached to the pump is a length of tubing, through which the insulin flows from pump to body, and the infusion set: a small insulin needle or Teflon cannula that is inserted just below the skin and taped securely in place. The infusion set must be changed every second or third day to prevent infection. The new set is inserted into a different site on the body.
The pump is intended to be used 24 hours a day. A small amount of insulin is given continually (the “basal rate“), according to a programmed plan unique to each pump user. This insulin keeps blood glucose in the desired range between meals and overnight. When food is eaten, the user programs the pump to deliver a “bolus” of insulin that is matched to the amount of food that will be consumed. It’s important for prospective pump users to realize that the pump does not measure blood glucose levels, nor does it program itself. The user must do these tasks.
Children sometimes worry that the pump will fall out if they hang upside down on the monkey bars or during active sports. Parents tend to worry about their ability to learn something new, about having to inform their child’s school about something new, about hurting their child, and about the pump getting disconnected during sports. These and any other fears must be addressed in an adequate way to alleviate these concerns. Children and their families are told that they can still do anything they did before and that the diabetes team will be there to address any issues that arise once pump therapy is started.