Insulin Injections

Insulin Pump for Children: How good an option

Most people who take insulin to manage diabetes inject the insulin with a needle and syringe that delivers insulin just under the skin. Several other devices for taking insulin are available, and new approaches are under development. One such device is the insulin pump. External insulin pumps connect to narrow, flexible plastic tubing that ends with a needle inserted just under the skin near the abdomen.

The insulin pump is about the size of a deck of cards, weighs about 3 ounces, and can be worn on a belt or carried in a pocket. Users set the pump to give a steady trickle or "basal" amount of insulin continuously throughout the day. Most pumps today have the option for setting several basal rates. Pumps release "bolus" doses of insulin (several units at a time) at meals and at times when blood glucose is too high based on the user's programming. Frequent blood glucose monitoring is essential to determine insulin dosages and to ensure that insulin is delivered.

Different approaches under development are:

Implantable insulin pumps

These are surgically implanted, usually on the left side of the abdomen. The pump is disk shaped and weighs about 6 to 8 ounces. It delivers a basal dose of insulin continuously. Users deliver bolus insulin doses with a remote control unit that prompts the pump to give the specified amount of insulin. An advantage of this method is that, like insulin produced naturally from the pancreas, the insulin from the pump goes directly to the liver to prevent excess sugar production there.

The insulin patch

This is placed on the skin and gives a continuous low dose of insulin. To adjust insulin doses before meals, users can pull off a tab on the patch to release insulin. The problem with the patch is that insulin does not get through the skin easily.

The inhaled insulin delivery system

This system provides insulin as a dry powder inhaled through the mouth directly into the lungs where it passes into the bloodstream. This aerosol delivery system is about the size of a flashlight and uses rapid-acting insulin.

In case of children

Insulin pump therapy can help in case of type 1 diabetes, as it delivers insulin in a way that resembles the body's own release of insulin. They can improve blood sugar control, make low blood sugar (hypoglycemia) less of a problem, and lessen the risk of diabetic ketoacidosis. However, the use of pump in children, especially very young children, is a matter of debate.

Pump therapy delivers rapid- or short-acting insulin continuously through the needle. The continuous insulin is called the basal rate. In addition to providing basal insulin throughout the day, pumps are programmed to give additional insulin with each meal and snack, called the bolus doses.

Although pumps can improve diabetes control and give children more flexibility, very young children cannot manage their own pump use. Even older kids need a good deal of help from parents. Therefore, pump therapy requires a knowledgeable parent or caregiver to be on hand 24 hours a day, 7 days a week to help with blood sugar tests, determine mealtime insulin needs, adjust pump settings, and troubleshoot any problems.

Parents need to consider the following before going for insulin pump for their children:

• willingness of the child to wear pump
• ability to tolerate the needle-insertion process

Before making a final decision, parents need to discuss with their child's diabetes health care providers. They also need to weigh the pros and cons of their own family situation. They may consider wearing a pump besides having the child wear one for a few days to see what it's like. All these would help parents make an informed choice.

They also need to know about the following apart from their own understanding of basal-bolus insulin therapy

• counting of carbohydrate or use some other insulin-to-food ratio
• correction for high or low blood sugar levels
• changing insulin doses for changes in exercise, sick days, travel, or other special situations
• measurement of ketones and their management if present
• confident of operating the insulin pump apart from sparing time for child's care

Parents of diabetic children can manage insulin pumps better with the help of the following:

1. They need to include a doctor, a diabetes nurse educator, a registered dietitian, a mental health professional, and other health care professionals as part of their diabetes management team.
2. Having a 24-hour telephone contact for patients who use insulin pumps
3. Having partnerships with school personnel and other caregivers who are willing and able to work with a pump

Apart from these, older children or the parents of younger children need to test the blood sugar four to eight times a day to check the pump's effectiveness, adjust mealtime boluses, and correct high blood sugar levels.