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To Pump, or Not to Pump?

by Deborah Butler, MSW, LICSW

Some people also worry about the pump delivering too much insulin, but this is a highly unusual problem since the pump possesses multiple safety checks to ensure that this will not occur.

Setting up basal rates and bolus doses takes time, effort, and extra blood glucose monitoring. Some diabetes care providers ask pump users to fast for three to four hours at a time to help determine basal doses, and some recommend blood glucose monitoring before and after meals to check whether bolus doses are set correctly. It may take a few weeks to a few months to figure out the correct basal rates and bolus doses and feel more comfortable with the dosing. And because insulin requirements change for growing children, it may be necessary to repeat the whole process periodically.

Another challenge of pump use is the expense. An insulin pump and pump supplies can be more expensive than injections, so if you do not have adequate health insurance coverage, you may want to consider the additional costs associated with pump use before purchasing one. Health insurance generally reimburses 80% of the cost of a pump under durable medical benefits, but this varies, depending on the policy. If you are having trouble getting insurance coverage for a pump, a pump company representative may be willing to talk to your insurance company directly on your behalf.

Is your child a pump candidate?
Starting an insulin pump is a big project that requires time, commitment, and learning new skills. Here are some things to think about if you are wondering whether your child would be a good pump candidate and if now is a good time to start pump therapy. One thing you may not need to worry about is age: Researchers have found that children as young as toddlers can do well on the pump.

Talk to your child. First of all, make sure that your child is interested in using a pump. Your child is the person who will be wearing it all of the time, so make sure that your child is interested in pump therapy.

Assess your child’s current diabetes management. If you are having trouble with your child’s current diabetes treatment plan, you may want to hold off on starting a pump, because pump management can be more complex than injection therapy. For example, if you are not presently using carbohydrate counting, if you or your child forgets to check his blood glucose levels regularly, or if your child misses insulin injections on a regular basis, you and your child may not be ready for the pump.

Learn more about pumps. Both you and your child should talk to your child’s health-care team about the pump and, if possible, talk to other families who have a child using a pump. It is important to discuss the pros and the cons of pump therapy and become educated about how the pump works and what is involved in maintaining optimal pump therapy.

Examine your expectations. A lot of people think that using a pump will automatically bring about better blood glucose control, but this is not the case. Some people think that the pump is automatic and gives insulin according to the body’s needs, but it does not. So-called closed-loop systems, which both sense blood glucose level and deliver insulin, are not yet available. The current pumps only provide insulin as programmed by the user. Although some people eventually achieve better blood glucose control with a pump, there is usually an initial adjustment period after starting it, so you may not see the improved blood glucose results you are hoping for immediately. Even though the newer insulin pumps have software to help calculate bolus doses and keep track of how much insulin has been delivered over the course of the day, you still need to be the “brain” for the pump. The pump is not a cure for diabetes; it is just a different method of delivering insulin.

Think about timing. During the pump initiation phase, it is necessary to check blood glucose levels several times a day and also during the night. Given these requirements, you will want to give some careful thought to when to start the pump. Your child may not want to start the pump during final exams, before a major trip, right before he is leaving to go to sleep-away camp, or right before he leaves for college for the first time. Parents may want to avoid starting the pump during their busiest work time of the year or if they are expecting another child. Some families choose to start the pump in the summer or during a school vacation. Pump initiation may also depend on the availability of appointments with your child’s health-care team members.

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Also in this article:
Before You Get a Pump
For Further Reading



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