Introduction: We decided to start using an insulin pump when Q was in kindergarten. Five-and-a-half years later and we have never looked back. It was one of the best decisions that we made for our child’s care. It is one of the pieces of technology that has given her more independence over the years. Pumping isn’t for everyone and there is a learning curve. If you are thinking about a pump, what follows is some of the pros and cons of using an insulin pump.
This is an excerpt from the chapter called “Diabetes 101.”
Advantages and Disadvantages of the Insulin Pump
Admittedly, my initial inquiry about the insulin pump was met with skepticism by the nurse practitioner we sometimes saw in place of our regular endocrinologist. She said that Q was young and warned of the incredibly increased risk of diabetic ketoacidosis (DKA). I’m not one to take no for an answer, so I did my research, and during our next visit with our endocrinologist I made my case for switching to a pump, resulting in a green light.
Insulin pumping isn’t right for every child and every family. It is not a given that everyone with diabetes graduates from injections to a pump, and there is definitely a learning curve as you adapt to the new technology. But that being said, there are many benefits of pumping insulin that are attractive to people dealing with diabetes day in and day out.
•The biggest positive is that each site change lasts approximately three days and replaces 12 to 15 injections. The pump can measure insulin more accurately than you can using syringes or pen needles, giving boluses in dosages as small as 0.05 or 0.1 units, which is an advantage for little ones who require very small boluses.
•Most insulins work best when a bolus is given before the meal so that the peak of the insulin and the peak of the carbs are closely timed. How much Q eats at a meal is highly variable. Because of this, with injections we waited until after the meal to give her a single injection to cover all of her carbs. With the insulin pump we are able to correct her blood sugar before the meal and give at least a partial bolus, say for 30 carbs, before she begins eating. With just the push of a few buttons we can give her additional boluses if more carbs are consumed.
•There are indications that patients may improve blood sugar control by using a pump, and many people have fewer extreme blood sugar swings while on the pump.
•While injection therapy forces a stricter routine of meal and snack times, the pump allows more flexibility in mealtimes. Some families eliminate between-meal snacks or go ahead and give insulin to cover them. And for those who exercise, basal rates can be reduced or suspended to help avoid exercise-induced hypoglycemia.
•One of the biggest bonuses is that it makes diabetes management easier overall. Insulin pumps generally allow you to enter in the blood sugar reading (this can be done automatically for pumps with an integrated meter) and the number of carbs, and the pump calculates the exact bolus needed. The pump takes into consideration the time of day, as well as insulin-to-carb ratios, correction factors, and insulin-on-board (IOB) to determine the units of insulin to be delivered. That’s right, no more diabetes math!
Of course there are a couple of trade-offs. With any technology, there is troubleshooting involved. Pump sites might fail, tubing might get kinked, cannulas might come out, and you will have to deal with these issues if and when they occur. Some but not all children have elevated blood sugar in the hours after a site change. Your pump trainer or diabetes educator can give you some tricks to try if this happens to you.
The biggest negative is the increased risk of diabetic ketoacidosis. DKA results from a shortage of insulin; in response the body switches to burning fatty acids and producing acidic ketone bodies that cause symptoms and potentially serious complications. With injection therapy, the long-acting insulin works in the background to keep blood sugar even. But insulin pumps use fast-acting insulin for both mealtime boluses and basal insulin. If you give an injection of long-acting insulin, you know that insulin is working for the next 24 hours. If an insulin pump is not delivering insulin for some reason for a number of hours, blood sugar can rise rather high and ketones can develop. For this reason, endocrinologists suggest checking for ketones any time blood sugar rises above 250 or 300. We were given a “DKA Decision Tree” by our diabetes educator to guide our decision process when blood sugar is this elevated. In over two years of using an insulin pump, I have only had to give Q two injections by syringe when I couldn’t get her blood sugar to come down with her pump.
If you’d like to learn more about the book, you can read more on the Kids First, Diabetes Second book page. It’s available widely in print and as an eBook from book sellers such as Barnes & Noble, Amazon.com, and IndieBound. And if you do read it and find it to be a valuable resource, I would greatly appreciate if you could write a review on any of the online retail sites. Thanks!
Disclosure: This post contains affiliate links to booksellers.
Please remember that I never give medical advice. Ask your endocrinologist or pediatrician for advice about your own child. Make your own informed decisions for your own child.