By Allison Blass

With 80,000 pump users, and 1/5 of them under the age of 20, pumps for diabetic children are becoming more and more popular. The popularity of the pump has proven to put pressure on families that still do injected insulin with syringes. The question remains whether or not the pump is right for the child or if it would best to stay with the injections.

Technobabble Basal rate- the amount of insulin given to you throughout the day. Bolus- the amount of insulin you take at a meal or snack. Infusion set- the outer part of the cannula. Priming- a term used for getting the insulin flowing inside the tubing. Reservoir- the holder for the insulin inside the pump. Cannula- a small plastic tube inside the body.

The Pump:

For those who are unclear on what a pump is, an insulin pump is a method of insulin therapy where a small pager-sized machine is hooked up to the body twenty-four hours a day supplying the body with insulin. Doctors have said that the pump is much like a regular pancreas, as a pump will be programmed with a basal (the amount of insulin given to you throughout the day, excluding meals). The pancreas works in a similar way, dribbling insulin into your body thoughout the day, instead of all at once. At meals, a bolus (the amount of insulin given at meals) is given to take care of the food. A bolus amount will vary depending on the number of carbohydrates that are being eaten, so there is more freedom with food.

Medtronic Minimed 508

No More Shots!

Freedom from shots and the freedom to eat more of what they want is a major part of why a diabetic will go on the pump. Jenna Queenan, 15, says, "I wanted more freedom in my life and more control over the diabetes. I got the pump because, basically, I wanted to be able to eat what I wanted to, when I wanted to." With a pump, a diabetic is able to add all the carbohydrates that will be eaten, or have been eaten, and then give the right amount of insulin. Since the insulin used is short-acting Humalog, some diabetics, especially younger children, can sometimes wait until after they eat to "bolus". Another benefit is that there is no long-acting insulin to cause diabetics to go low later, so meals and snack timing is much more flexible. Cheryl Bayne, mother of Natalie, 9, says, "Now Natalie can eat a chef salad for lunch if she chooses where before it did not have enough [carbohydrate] grams."

The Good…

Benefits from the pump range from lower A1Cs, less frequent highs and lows, and the flexibility in the schedule. "My A1C has gone down from 8.0 to 7.7. I was really glad," says Hannah Smith, 10.

Disetronic H-Tron

Chris Graham, 10, says, "A1C's are lower, [and I have] less lows now." Cheryl notes, "[A1C's have] always been good, around 6-7, however with the pump there are less extreme lows and less extreme highs."

And The Bad…

However, the pump can be tricky to manage and can cause problems of their own. Kinked sets or pump tubing ripping off the body can keep insulin from reaching the body, causing Ketoacidosis (DKA). Forgetting to bolus is also a common problem for diabetics. With the added freedom of the pump, waiting until after a meal to bolus is common, and so is forgetting about it. Cory Graham, 11, says his main problem is forgetting to bolus for meals or snacks. DKA is a serious problem, and pump-users should be keep track of their numbers and check to see if the cannula (the plastic tube inside the body) is kinked and not giving insulin, but sometimes the problem is a little more obvious. "Since I've had the pump, which is about 1 1/2 years, I've gone into DKA about 5 or 6 times, normally because the tube comes out of my stomach," Jenna says. Keith Gonyea, 15, agrees, "My only problem is the site getting pulled out."

Pump Links MiniMed.com Disetronic.com Insulin-pumpers.org pumpgirls.com

Which One?

For as long as pumps have been around, there has been the debate between which is better: Medtronic Minimed (previously called Minimed), Disetronic or lesser-known ones, like Animas. Potential pump users should research each pump carefully, looking at the benefits and disadvantages between each one. Recommendations and reliability are key factors for people in deciding which pump. For Kaisha McGreal, 9, and Jenna, the choice was Medtronic Minimed. Kaisha says, "My mom liked all the positive comments about the Minimed, the support, and the features on the pump." Jenna adds, "I haven't tried any of the other pump companies but I think Minimed has less buttons and is easier to understand and handle." Disetronic has the benefit of being one of the only waterproof pump. Minimed is considered only water-resistant. Cheryl says, "We liked the waterproof quality of the Disetronic." For children who swim a lot, the Disetronic is an ideal choice, though not for everyone.

The Age Factor

The pump is a huge undertaking, and the age of child can complicate things. It is a general rule of thumb that the older a child, the better the child will be to handle a pump. Responsibility is an issue and most doctors prefer children to be older and have experience with diabetes before putting them on the pump.

Animas R1000

However, more and more children have been going on the pump at a younger age. David Dietz, father of Allie, 7, says, "Allie is seven and she understands her diabetes and she is very good at operating the pump. I think that it is more a matter of understanding than age." Keith points out that, "If they have a pump earlier then they have tighter control and less chance of complications later in life."

The responsibility and maturity of the child is important when deciding if the pump is right for a child. Since the pump is on the child twenty-four hours a day, the child must be ready to handle whatever may go wrong with the pump. The younger the child, the more involved a parent will be. Cheryl says, "The parents must be readily available at all times to ensure success with the pump for the child." Also, the more in control a diabetic is, the easier it will be for a child to adjust to having the pump. Pump users generally test their blood sugar between 5-10 times a day. If the diabetic is already used to testing often and at regular times, the easier to detect any problems that might happen with the pump. Keith recommends, "Check you numbers often. I have gotten really high when my site went bad."

Famous People With Pumps Larry Soler, JDRF Senior Legislative Counsel Nicole Johnson, Miss America 1999 The Pump Girls, a pop singing group Clare Rosenfeld, Former ADA National Youth Advocate

Returning to Shots

With the added responsibility of the pump and having a machine attached to the body twenty-four hours a day, returning to shots is always a possibility for pump users. But would anyone return to them?

"Once, my pump was not working right and I had to return to shots for a couple of hours. It made me [realize] how much they program your life. I like the pump a lot and I don't even consider returning to shots," Jenna says. Cheryl agrees, "We would only be going backward. We are now accustomed to some degree of normalcy."

There are a few occasions when not having the pump would be nice. Swimming and beach trips would be made easier if the pump was not there. Keith admits, "I have considered returning to shots so I could go to the beach and pool and just not worry about the pump." Brad Pitt, 16, adds, "There are times when the pump is bulky and inconvenient - like at the beach or going to concerts where there is a mosh pit. But, I'd prefer to stay on the pump."

The pumps advantages seem to outweigh the times when going back to shots might be more convenient. As Kaisha sums up, "No! Because it hurts a lot!"

CureNow Would Like To Thank:
Jenna Queenan, Keith Gonyea, Kaisha McGreal, Cheryl Bayne, David Dietz, Jennifer Dietz, Brad Pitt, Chris Graham, Cory Graham, and the Juvenile Diabetes Research Foundation.