Insulin pumps can improve glycemic control and allow more precise and flexible insulin delivery for adults with diabetes, but are they suitable for children?
In this article we focus on the use of insulin pumps for children and answer questions such as can your child wear an insulin pump and is he a good candidate for one?What are the advantages and disadvantages of children using an insulin pump?Is there a minimum age for a child to use an insulin pump?
What is an insulin pump?
An insulin pump is a small electronic device that delivers fast-acting insulin to the body in the amount and when it is needed.They can be worn for 2-3 days in a row.
There are two main types of insulin pumps:
- Tubed, sometimes called traditional pumps or connected pumps
- Tubeless, also called "patch pumps"
The traditional insulin pump delivers insulin through a small catheter (a small tube with a needle) that is inserted under the skin and secured with an adhesive.This is called an “infusion set” or “infusion cannula.”
The plastic tube connects the infusion set to the pump and delivers insulin from the pump to the skin.
The "patch pump" does not use a tube, but is applied directly to the skin with the help of a patch.Tubeless patch pumps contain a reservoir of insulin.Insulin is administered through the infusion cannula and the pump is controlled remotely using wireless technology.
Wireless pumps deliver insulin in two ways:
- A basal rate: a continuous infusion of rapid-acting insulin throughout the day and night
- Bolus dose: additional correction doses are given at the time of meals or snacks
Most insulin pumps have a bolus calculator that calculates the recommended bolus dose using current blood glucose levels, the user's total grams of carbohydrates, and remaining insulin from previous doses.
Can my child use an insulin pump?
Insulin pumps can be used in children and adolescents with type 1 diabetes and provide many health benefits.However, there are some important factors to consider when deciding whether one is best for your child.
Some aspects that parents and caregivers should carefully consider are:
Does the child want to wear an insulin pump?
Will the child tolerate the process of inserting the insulin pump, which involves the use of a catheter and a small needle?
Does the parent/caregiver understand well what insulin treatment entails?
Does the parent/caregiver and/or child or adolescent know how to calculate the amount of carbohydrates consumed?
Does the parent/caregiver know how to use an insulin pump?
Does the parent/caregiver have “allies” among teachers and other caregivers who are willing and able to use an insulin pump?
Is the child willing to have several blood glucose tests each day?Is the parent/caregiver willing to help you?(Blood glucose typically needs to be measured 4 to 6 times a day to adjust bolus doses, make sure the pump is working properly, and blood glucose levels are monitored.)
Do the child and parents have a team of medical professionals willing to help and support them during the process of establishing insulin pump treatment?
It's also important to remember that you and your child will have to learn a lot about insulin pumps in order to use them.
It is recommended to start insulin pump treatment with a specialized medical team (composed of a nurse, a doctor and a dietitian with experience in its use), and not with a primary care doctor (such as your family doctor).
What are the advantages of using an insulin pump for children?
There are many advantages of a child using an insulin pump, many of them similar to those of adults:
Insulin pumps allow multiple rates of basal insulin to be delivered, delivering small doses approximately every 10 minutes.This mechanism tries to imitate the activity of a healthy pancreas.Together with the control of blood glucose levels, they allow more precise and personalized insulin administration.
Insulin pumps can improve glycemic control and diabetes outcomes and help children lead a more flexible lifestyle.Adjusting insulin doses when exercising or traveling is easier with a pump.Insulin pumps can reduce hypoglycemia during and after exercise for young people with type 1 diabetes.
Insulin pumps make it easier to adjust basal insulin rates in other special circumstances, such as skipping meals, eating less, or being sick, in a way that treatment with injections does not allow.
Bolus insulin doses allow you to control blood glucose levels more easily and comfortably after eating, as well as reduce high glucose levels.
A common observation after the adoption of insulin pump therapy is a reduction in both the frequency and severity of hypoglycemia in children and adolescents with type 1 diabetes. Insulin pump therapy is also associated with a lower rate of hypoglycemic coma compared to injection therapy, especially in school-aged children.
The risk of diabetic ketoacidosis is also lower in youth who use insulin pumps compared to youth who receive treatment with multiple injections.
Studies have shown an improvement in the quality of life of families whose children use insulin pumps.
What are the disadvantages of using an insulin pump for children?
Insulin pump treatment for children also has some problems that must be seriously considered:
Very young children cannot operate the pump without help from parents and caregivers.Even older children may need a lot of help.
Children may forget to bolus insulin after eating;"Forgetfulness" is the most common reason for skipping boluses and is a major challenge for children and adolescents who use insulin pumps.
Since children spend most of their time in school, teachers may need to receive education on topics such as insulin pumps, blood glucose measurement, ketone measurement, emergency response, or pump troubleshooting.
The risk of complications such as ketoacidosis may discourage the use of insulin pumps.If the insulin pump breaks down or the infusion set becomes dislodged or clogged, ketoacidosis can occur within 3 to 4 hours.This is because the pump delivers small doses of rapid-acting insulin, so long-acting insulin cannot be used.
Insulin pump treatment has been associated with weight gain, which can be especially distressing for adolescents.
There is a risk of skin infections at the insertion site of the cannula.Infusion site infections are the most common complication associated with insulin pump therapy, and can cause inflammation, pain, redness, and swelling at the infusion site.
Children and teens may dislike the feeling of being “tethered” to their pump.
The cost of an insulin pump and supplies is higher than treatment with multiple injections.The relatively high cost of purchasing an insulin pump and maintaining treatment can be a major obstacle for many families.
One of the risks of insulin pump use is idiopathic hyperglycemia.Its origin may be due to possible mechanical problems, pump breakdown or problems at the infusion site.
It is important that you weigh the pros and cons of insulin pump treatment for children before making a decision.Your medical team will be able to help you.
What is the minimum age to use an insulin pump?
There is no internationally established minimum age for using an insulin pump.
Insulin pumps are typically offered to children under seven years old.Many studies demonstrate the benefits of using an insulin pump even in very young children, such as improved glycemic control and reduced hypoglycemia compared to using multiple injections.The advantages that insulin pumps offer in controlling unpredictable eating habits and low insulin requirements in very young children may make insulin pump treatment a good option for many children with type 1 diabetes and their families.
However, it is worth noting that some trials have shown that there is no difference in glycemic control in children under 7 years of age between insulin pump treatment and multiple injections, and that more randomized (and larger) studies need to be conducted to fully understand the advantages and disadvantages of insulin pumps for children.
According to clinical guidelines from several diabetes organizations around the world—the International Society for Pediatric and Adolescent Diabetes or the Endocrine Society—insulin pump therapy can benefit all people with type 1 diabetes “regardless of age.”
It is important to remember that the use of insulin pumps in different age groups can present unique challenges.You can discuss the most appropriate options for your child with your medical team.
Should your child use an insulin pump?
There are several important factors to consider before purchasing an insulin pump for your child.
Studies show that insulin pump treatment offers many benefits to children with type 1 diabetes, although, as with any treatment, it also has disadvantages.
Using an insulin pump requires effort, commitment, and a willingness to learn, especially in the beginning.
However, with education, diligence, and support, insulin pumps can improve your child's quality of life.Additionally, insulin pump technology is advancing very rapidly.As market options expand, this treatment will become more comfortable and widely available.
Sources
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Maahs, David M., Lauren A. Horton, and H. Peter Chase.The use of insulin pumps in youth with type 1 diabetes.Diabetes technology &therapeutics 12.S1 (2010): S-59. Link
Potti, Lakshmi G., and Stuart T. Haines.Continuous subcutaneous insulin infusion therapy: a primer on insulin pumps.Journal of the American Pharmacists Association 49.1 (2009): e1-e17. Link
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