INSulin PUMP THERAPY FOR DIABETIC MANAGEMENT

The Use of Insulin Pump Therapy For Diabetic Management in Children Age 2-12 With Type 1 Diabetes

The Use of Insulin Pump Therapy For Diabetic Management

Introduction

Insulin pump therapy has been shown to be beneficial in pediatric patients with type 1 diabetes; however, there is little data on very young children with regards to the risk/benefit ratio of pump therapy. This article describes the outcomes of insulin pump therapy in young children in our center at Childrens Hospital Los Angeles aND the criteria for patient selection.

Purpose

Since the introduction of continuous subcutaneous insulin infusion (CSII) in the late 1970s, it has become apparent that the use of insulin pump therapy has many potential benefits for patients with type 1 diabetes.1,2 Because it offers a more physiological way to deliver insulin and, therefore, potentially improves long-term outcome,3 our center began to investigate its use in pediatric patients in the mid-1980s. Once it was shown that pump therapy had benefit in older children and adolescents with regard to improving glycemic control,4,5 reducing hypoglycemia,6 allowing for resumption of normal linear growth,7 and decreasing episodes of recurrent diabetic ketoacidosis (DKA),8 we became increasingly interested in evaluating its use in preschool and early school-aged children with diabetes. This article describes our experience at Childrens Hospital Los Angeles with insulin pump use in young children.

Literature Review

To select pump patients at our center, we have employed standard criteria that span medical, educational, and Psychological domains (Table 1). These are essentially the same for all potential pump candidates, including young children whose parents, rather than the child, must meet all of the educational criteria. From a psychological standpoint, all patients, regardless of age, must agree to wear the pump, and they must have tolerated catheter insertion before obtaining the pump to ensure that they understand what this basic component of CSII entails.

For success with CSII, patients/families must have the requisite skills and Knowledge, as well as the appropriate attitude to learn pump therapy.9,10 The skills and knowledge required beyond learning how to insert, disconnect/suspend, protect, and program the pump include understanding and successfully using Carbohydrate management/counting, correcting blood glucose levels outside the target range, sick-day management, and how to adjust for exercise and changes in activity pattern. For young children, all of these must be done by the parent(s) and adult(s) who supervise the young child. As shown in Table 2, our center has developed an eight-stage Competency system. The parent(s) of pump candidates must reach the fifth level to be considered capable of managing CSII for their young children.

Advantages and Disadvantages of CSII in Young Children

CSII has some potential advantages and disadvantages for young children. For many young patients, it is easier and more convenient to take multiple daily doses of insulin with CSII than with a syringe or insulin pen. Because of erratic eating patterns, subjects can dose after eating and/or use a square wave bolus to better match food absorption and insulin ...