Insulin pump therapy in Type 1 pediatric patients: now and into the year 2000

✍ Scribed by Francine Ratner Kaufman; Mary Halvorson; Debbie Miller; Marsha Mackenzie; Lynda K. Fisher; Pisit Pitukcheewanont

• Publisher: John Wiley and Sons
• Year: 1999
• Tongue: English
• Weight: 270 KB
• Volume: 15
• Category: Article
• ISSN: 1520-7552
• DOI: 10.1002/(sici)1520-7560(199909/10)15:5<338::aid-dmrr57>3.0.co;2-y

✦ Synopsis

There are a number of medical conditions such as growth failure in children, pregnancy, lipid abnormalities, and early complications that are improved by the meticulous glycemic control that can be achieved with insulin pump therapy (CSII). By using an insulin pump, many patients with severe hypoglycemia, the dawn phenomenon, extremes of glycemic excursion, recurrent diabetic ketoacidosis (DKA) and hypoglycemia unawareness have amelioration of these problems. However, pump therapy involves problems such as weight gain, recurrent ketosis due to pump failure, infections, and risk of hypoglycemia.

Owing to many developmental issues, young children may not be able to wear the pump without parental supervision. We have used the pump at night time only in these patients. This has allowed children of 7±10 years of age to bene®t from improved nocturnal glycemia without the risk of pump therapy when they are without an adult to help. We have also used the pump in subjects with recurrent DKA and in our general patient population (mean age 13.6t3.9 years). In our pump cohort, CSII led to improvement in quality of life, knowledge, adherence, and responsibility. A reduction in hypoglycemia, DKA rate and mean HbA 1c was associated with pump usage. For this to occur, however, pump education must be geared to the pediatric subject and his/her family. Education materials and tools help in learning how to use the pump and how to deal with the intricacies of basal and bolus dosing, and the effect of exercise, food and illness on diabetes management.

The pump has improved since it was ®rst introduced and these modi®cations have made it easier, more painless and less hazardous. With the development of continuous glucose sensors and implantable pumps, the next century will see pump therapy lead to the arti®cial pancreas.