Injecting or Pumping?

by Leighann on August 1, 2009

My daughter was diagnosed with Type 1 diabetes about 15 months ago.

Although things are going well enough for us, I will not exaggerate and say that life is back to normal.

Rather, it is our new normal.

MULTIPLE DAILY INJECTIONS

She receives four injections a day. Three are fast-acting insulin given at mealtimes to cover the food that she eats and to correct for high blood sugar and the other injection is long-lasting insulin administered at bedtime.

Though her A1C has come down since her last visit to the endocrinologist, it is still above where we should be. And I can’t quite figure out what we are doing that could be tweaked.

The nurse practitioner suggested modifying her afternoon snack to try to bring down her blood glucose level at dinner.

The thing with multiple daily injection therapy is that you have to run a very tight ship. Schedules have to be stringent. Three meals, three snacks all timed so that the fast-acting insulin works as best that it can while her blood glucose levels go up and down in peaks and valleys while the long-lasting insulin works in the background.

Because of meal spacing, her bedtime has been pushed back to 9 pm, which I consider too late for a five-year-old. But dinner beginning at 6:00 with her post-dinner injection about 6:30 means that her bedtime snack and injection can’t occur until 8:30. After which comes teeth brushing and reading.

Another consequence of the injections is loss of spontaneity. Every excursion, every walk around the block, every playdate, every single thing we do has to be planned around meal and snack times. To the tee.

Long gone are the days that we can just decide to take a long walk to the park. Now the kids stand, toes tapping, while I gather all of our supplies and snacks and emergency juice, before we can embark on any adventure.

And when we are at the park or on a long walk having fun, I have to check the clock to make sure that we are back home in time for a scheduled meal.

In some ways it really sucks the fun out of life. The carefree life a five-year-old is supposed to have.

THE PUMP

At BlogHer, two different adult Type 1 diabetics (Allison and Kerri) told me that the pump has made all the difference in the world and that I should look into it for my daughter. (I also briefly met another diabetic and noticed that she was wearing a pump.)

The hospital where we are seen is notorious for delaying when a child can begin using an insulin pump. I do believe that we have received excellent care at this top 5 children’s hospital. But I know families who have chosen to go to other hospitals because they will put children on pumps earlier.

Not to mention that our hospital is over three hours away!

Three visits ago we asked about the pump and the nurse said it wasn’t an option yet. Two visits ago we saw the actual endocrinologist and when I mentioned the pump again she said that the deciding factor for her is the amount of Lantus that a child is on (Lantus being the long-acting insulin). At our visit in the past week I again asked the nurse practitioner and she said that we could begin researching the pump.

Though I will say that she didn’t seem too enthusiastic. She said that when we decided which pump we wanted to call and let the nurses know.

I asked what the advantages and disadvantages of both multiple daily injections (which we do now) and the insulin pump are.

She said that basically with the pump there is a risk of DKA (diabetic ketoacidosis) because you can’t be entirely sure that the pump is actually delivering insulin as it should.

I am actually a bit surprised that this is being left up to us to decide and research.

Here are what I see as the pluses and minuses:

Injections:
-Tied to a strict schedule
-Four or more injections by pen needle and/or syringe per day
-If she wants to eat additional food after receiving her injection, then she must get yet another injection
+ We are comfortable doing injections and with this type of management since it’s all we know

Pump:
-It will require us learning a new system
-The insertion might be painful
-Our daughter may be scared of something new
-Risk of ketoacidosis
+Flexibility of meals and snacks (she can eat when she’s hungry)
+We can bolus for food as she begins eating and get another bolus if she wants more (currently she gets her injection at the end of mealtime since how much she eats varies so widely; because of this her blood sugar begins to rise before she gets the insulin)
+New insertion set every three days instead of four injections a day
+We are already great about counting carbs (and measuring and weighing)
+Lower A1C

So here are my questions for diabetics (or parents of diabetic children):

Do you use a pump or get injections and why?
If you use a pump, which one did you choose and why?

Am I delusion thinking that the injections aren’t that hard on my daughter because the majority of the time she doesn’t complain? Or is she just putting on a brave face and has accepted that its her lot in life?

I think at this point I am most interested in the OmniPod since it is an all-in-one unit that inserts itself and does not have to be disconnected during baths and swimming. I also like that there is no tubing for her to get caught on and she won’t have to wear a fanny pack.

That being said, I am sure that the half a dozen pumps on the market all have their merits.

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{ 3 comments… read them below or add one }

1 Misty August 4, 2010 at 9:28 am

sounds like you are defiantly doing your homework, which is good so you know what you are getting into! My daughter was dx in February of 2008 and was pumping 3 months later…for us this was the best decision ever! i felt like it would give her allot more freedom as well as just becoming a part of her life so it would not be this thing she has to wear or get used to. i wore the pump myself for a couple days and having the tubing drove me nutts but maybe because she was so young it didnt seem to phase her a bit, she still plays and climbs everything as usual (you would be supprised how durable they are lol) we use numbing cream so site insertions have very rarely been painful and then its usually mommy error instead of the site itself.When she first started we had to go on the animas 2020 due to the low basal increments offered for how sensitive she was to the insulin at that point, it was a great pump, customer service was great and it was easy to use…we have just recently switched to the new medtronics revel so that we could have a cgms as well all in one unit. We have only been using the revel about a month or so but so far we love that one as well …more so because it has the cgms ! I also have diabetes but i was diagnosed as an adult after her (strange i know) and i am working on getting a pump right now but for myself i am choosing the omnipod for the very reason it is tubeless, i like some of the features offered in the revel like say the cgms but im willing for myself as an adult to give up some of those for the freedom of no tubing but there are lots of children who love there pod’s as well ! My point to all this rambling is do your homeowork, pick the one that youthink will best fit your family and your child and go for it ! if she dosent like it or you decide maybe your not quite ready you can always go back to mdi and give it another shot later, its not like they take the pump back if you switch back …and in my opinion it does make life so much easier !

good luck to you and your family in your journey through life with D!

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2 Leighann August 4, 2010 at 9:42 am

Thanks for you comment Misty.

OmniPod has plans of incorporating a Dexcom Seven Plus into the PDM in the future. Read about it here: http://www.d-mom.com/quick-bite-omnipod-news/

For our daughter, we did end up choosing the OmniPod and LOVE it. It really works for our family.

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3 Tonya August 4, 2010 at 3:02 pm

Ok! You have looked into a lot so far. Our story is.. my son was diagnosed at 9 years old (almost four years ago) He was on MDI for 13 months before he had any thoughts about the pump. The schedule with MDI is very very hard and makes it tough to just be a kid. My son decided he wanted the freedom of eating when he wanted, sleeping in, ect. He has been on the pump almost 3 years now and wouldn’t give it up for the world. I chose to go with the Medtronic Minimed Paradigm 722 Series. I chose it for the reason of the integrated CGM (I haven’t been able to afford to get the CGM yet, but the option is there) We are up for renewal in 1 year and I will DEFINATELY get another Minimed Pump. Their service has been fantastic. They even sent 2 of their doctors out to our house when we were having continual site issues to help us get through it. The risk of DKA is greater with Pump Therapy, but in 3 years we have never had DKA. He has had Ketones, but we know how to control that. Give an injection of insulin. We also Use EMLA Cream for insertion (a topical numbing agent you put on an hour before) and he rarely ever feels a thing. He is now 13 and sleeps till noon if he wants, plays Full Contact Football, Volleyball, Basketball and more. I wouldn’t agree with the nurse saying the greater risk of lows. The beauty of the pump is you can set different basal rates for different times. For instance, my son spikes his blood sugar starting around 7am so we increase his basal rate a coupple hours before. He starts Football practice at 6 and I know his excercise will make him go low, so we decrease his basal rate a couple hours before. He tends to go low after footbal so I put him on a temp basal of 90% for 8 hours. All this is easily done. With MDI’s I have to plan 24 hours in advance what activities he is doing. I know it sounds complicated, but it’s no more complicated than learning what to do with MDI’s. It is important to have a doctor who is on board with the pump because you will need their support as well. All of the pump companies will come out and do a “test drive” with their pump and let your daughter where a different one for a couple days (with saline in it) and let her pick. They come in all kinds of colors which is sometimes important to girls. Feel free to contact me if you have any questions.

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