Insulin Pump Is Suitable for Many Diabetic Children

SAN FRANCISCO — Many children with diabetes do quite well on insulin pumps, but patient selection is important, according to Dr. Stephen E. Gitelman.

“We studied toddlers. We studied teens. It turns out [pumps] can work well on any age group,” he said at a meeting on clinical pediatrics sponsored by the University of California, San Francisco. “The people that do best are those where the child is motivated to use the pump and there's a supportive and involved family who's going to help him.”

Pumps can work well in toddlers with newly diagnosed type 1 diabetes, or teenagers who have been giving themselves injections for years. Pumps are suitable in children with low HbA_1c or high HbA_1c levels. And pumps are even suitable in some children with type 2 diabetes who have failed oral medication, said Dr. Gitelman, a pediatric endocrinologist at the university.

Although a pump may provide more glycemic control than is necessary in the early course of diabetes, Dr. Gitelman said that there is evidence that tighter glycemic control may preserve beta-cell function.

Dr. Gitelman offered several tips for selecting suitable pump candidates. The successful pediatric pump user will have already shown solid diabetes self-management skills (e.g., the child will be monitoring glucose four or more times each day and will be counting carbohydrates).

The child needs to have sufficient manual dexterity to operate the pump, and cannot be technophobic.

Dr. Gitelman said about one-third of the children with diabetes in his practice are using the pump successfully. Most children are eager for the pump because they know it means no more shots. Other benefits include better overall control, less risk of hypoglycemia, and improved quality of life.

However, use of the pump carries risks, he said. For example, infections at the catheter placement site can be a problem. The pump is used only with short-acting insulin. If something goes wrong with the pump or the catheter gets dislodged, the child can be in diabetic ketoacidosis within just 4–6 hours.

And some children don't like wearing the device, which is difficult to conceal. When people notice it they frequently ask questions, requiring the child to launch into a discussion of diabetes.

And then there are the financial issues. A pump costs $5,000–$6,000, and supplies run about $100 per month. Fortunately, most insurers pick up this cost for children, he said.

“The more we use pumps, the more we start to feel that the bottom line is anyone who is on insulin therapy could benefit from them,” said Dr. Gitelman, who did not disclose any conflicts of interest.

SAN FRANCISCO — Many children with diabetes do quite well on insulin pumps, but patient selection is important, according to Dr. Stephen E. Gitelman.

“We studied toddlers. We studied teens. It turns out [pumps] can work well on any age group,” he said at a meeting on clinical pediatrics sponsored by the University of California, San Francisco. “The people that do best are those where the child is motivated to use the pump and there's a supportive and involved family who's going to help him.”

Pumps can work well in toddlers with newly diagnosed type 1 diabetes, or teenagers who have been giving themselves injections for years. Pumps are suitable in children with low HbA_1c or high HbA_1c levels. And pumps are even suitable in some children with type 2 diabetes who have failed oral medication, said Dr. Gitelman, a pediatric endocrinologist at the university.

Although a pump may provide more glycemic control than is necessary in the early course of diabetes, Dr. Gitelman said that there is evidence that tighter glycemic control may preserve beta-cell function.

Dr. Gitelman offered several tips for selecting suitable pump candidates. The successful pediatric pump user will have already shown solid diabetes self-management skills (e.g., the child will be monitoring glucose four or more times each day and will be counting carbohydrates).

The child needs to have sufficient manual dexterity to operate the pump, and cannot be technophobic.

Dr. Gitelman said about one-third of the children with diabetes in his practice are using the pump successfully. Most children are eager for the pump because they know it means no more shots. Other benefits include better overall control, less risk of hypoglycemia, and improved quality of life.

However, use of the pump carries risks, he said. For example, infections at the catheter placement site can be a problem. The pump is used only with short-acting insulin. If something goes wrong with the pump or the catheter gets dislodged, the child can be in diabetic ketoacidosis within just 4–6 hours.

And some children don't like wearing the device, which is difficult to conceal. When people notice it they frequently ask questions, requiring the child to launch into a discussion of diabetes.

And then there are the financial issues. A pump costs $5,000–$6,000, and supplies run about $100 per month. Fortunately, most insurers pick up this cost for children, he said.

“The more we use pumps, the more we start to feel that the bottom line is anyone who is on insulin therapy could benefit from them,” said Dr. Gitelman, who did not disclose any conflicts of interest.

SAN FRANCISCO — Many children with diabetes do quite well on insulin pumps, but patient selection is important, according to Dr. Stephen E. Gitelman.

“We studied toddlers. We studied teens. It turns out [pumps] can work well on any age group,” he said at a meeting on clinical pediatrics sponsored by the University of California, San Francisco. “The people that do best are those where the child is motivated to use the pump and there's a supportive and involved family who's going to help him.”

Pumps can work well in toddlers with newly diagnosed type 1 diabetes, or teenagers who have been giving themselves injections for years. Pumps are suitable in children with low HbA_1c or high HbA_1c levels. And pumps are even suitable in some children with type 2 diabetes who have failed oral medication, said Dr. Gitelman, a pediatric endocrinologist at the university.

Although a pump may provide more glycemic control than is necessary in the early course of diabetes, Dr. Gitelman said that there is evidence that tighter glycemic control may preserve beta-cell function.

Dr. Gitelman offered several tips for selecting suitable pump candidates. The successful pediatric pump user will have already shown solid diabetes self-management skills (e.g., the child will be monitoring glucose four or more times each day and will be counting carbohydrates).

The child needs to have sufficient manual dexterity to operate the pump, and cannot be technophobic.

Dr. Gitelman said about one-third of the children with diabetes in his practice are using the pump successfully. Most children are eager for the pump because they know it means no more shots. Other benefits include better overall control, less risk of hypoglycemia, and improved quality of life.

However, use of the pump carries risks, he said. For example, infections at the catheter placement site can be a problem. The pump is used only with short-acting insulin. If something goes wrong with the pump or the catheter gets dislodged, the child can be in diabetic ketoacidosis within just 4–6 hours.

And some children don't like wearing the device, which is difficult to conceal. When people notice it they frequently ask questions, requiring the child to launch into a discussion of diabetes.

And then there are the financial issues. A pump costs $5,000–$6,000, and supplies run about $100 per month. Fortunately, most insurers pick up this cost for children, he said.

“The more we use pumps, the more we start to feel that the bottom line is anyone who is on insulin therapy could benefit from them,” said Dr. Gitelman, who did not disclose any conflicts of interest.