From Nashville, Tennessee, USA:
I am having difficulty getting a straight answer from the endocrinologist about pumps. The pediatrician thinks it would be good, but the endocrinologist just skirts around the topic. When I mentioned the Children with Diabetes pump conference, I was told "Of course, they think you are a bad parent if you don't have your child on the pump!" The response I get from the endocrinologist is that we are controlling her blood sugar fine. In January 2005, her A1c was 6.9 and they told me that was too low. They want it 7.5 to 8.5. It has gradually gone up to 7.9. She has been having a lot of morning lows. I think what happens is I load her up with carbohydrates and then am afraid to give her a bolus.
Insulin pumps have very clear advantages and disadvantages for kids with diabetes. Their advantage is enabling kids and teens to better manage their diabetes and achieve desired hemoglobin A1c results. This can be done with insulin shots, but can be easier to achieve with the technology a pump provides. Another clear advantage is decreasing the number of injections that are needed as well as more precisely delivering insulin and being able to vary the amount of basal insulin that is given during the day and night. Some disadvantages of pumps include having a piece of hardware attached to you 24 hours a day and an increased chance of getting sick with diabetes -- diabetic ketoacidosis.
Your child's decision should be made on an individual basis and made only after becoming familiar with pumps and their advantages and disadvantages. You should also consult with your physician and an informed diabetes educator familiar with pumps.
Additional comments from Dr. Philip Ledereich:It sounds to me like your child's endocrinologist is not that knowledgeable of pump technology and how to successfully manage children on pumps. It may be good idea to get a second opinion from another endocrinologist.
I know of one "pediatric" endocrinologist who only has one or two kids on pumps. I would never take my child to him. My son has been pumping successfully for several years now.
An alternative to reduce the risk diabetic ketoacidosis is to split the basal and replace some of it with Lantus, so if the pump fails, there always is background insulin (the Lantus), and DKA would not begin as quickly. See The Untethered Regimen by Dr. Steve Edelman.
Additional comments from Jeff Hitchcock, CWD Founder and Editor:I recall hearing from a family who attended our Friends for Life 2003 conference, who said that their child's endo had told them, "Don't go there. You'll come back wanting a pump!" When I heard that I was mystified that a health care provider would, in effect, try to conceal information about a tool that a family might find better meets their child's needs. What possible good can come from that behavior? It certainly doesn't instill a sense of trust and confidence in the doctor on the part of the family.
Our Focus on Pumping conferences are, as one might expect, all about insulin pump therapy. We have sessions that cover the basics, advanced pumping strategies, and selecting an infusion set, just to name a few. While most families who attend are already using a pump, some who come are interested in learning more about it. What better place could there be than a conference devoted to all aspects of pump therapy?
Finally, I would like to comment on the endo's assertion that "... they think you are a bad parent if you don't have your child on the pump." Nothing could be further from the truth. Our goal as parents is to ensure that our children receive the best diabetes care, so that they can be as healthy as possible and live life as if they didn't have diabetes, to the extent that that's possible. Some of us choose pump therapy, some of us choose multiple daily injections. Some of use choose both to accommodate summer activities like surfing. The point is that this is our choice, and we at Children with Diabetes support whatever choice a family makes.
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