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[IP] Fascinating Pump Progress
Received this article from another diabetes e-mail group. What struck me
(aside from the obvious story itself) was the POSITIVE "press" given to the
notion of pumps for young children by the ped endo quoted in the story.
Insulin pump for infant one for annals
ARIEL R. FRANK
A baby at Arkansas Children's Hospital is believed to be the youngest wearer
ever of an insulin pump for diabetes.
Maverick Colt Roe was born healthy, but a bit smaller than expected, on
July 22. Twelve hours later his temperature dropped, he began to breathe
rapidly and his blood glucose level skyrocketed to more than 1,000 milligrams
per deciliter -- about 10 times above the upper limit of normal.
Doctors first thought he had an infection in his bloodstream. But when
his blood glucose level continued to soar, they diagnosed neonatal diabetes.
The condition, which is temporary about half the time, is rare. And
insulin pumps in small children, let alone infants, are practically unheard
of. Experts said Wednesday that they had never seen or read of the device
being used in a child so young.
If Maverick continues to thrive on the pump, his case may mark a sea
change in the treatment of diabetes in children and babies.
Though insulin pumps have existed for two decades, they only began to be
widely used about five years ago and are still hardly prescribed in children
because they require so much attention.
The insulin dose delivered by the beeper-size device must be adjusted
according to a calculation, and the needle and catheter through which the
pump is attached to the skin must be changed regularly.
"It's very rare to have babies born with diabetes. It's like one in the
millions," said Dr. Richard Furlanetto, scientific director for the Juvenile
Diabetes Foundation in Buffalo, N.Y.
Though Maverick's form of diabetes differs slightly from juvenile-onset
or insulin-dependent diabetes, he is being treated the same way. The latter
disease strikes about one in 250 people nationwide and results when something
-- typically a toxin or virus -- prompts the body's immune system to assault
Certain cells of the pancreas become damaged and stop producing enough
insulin. Without insulin the body cannot get nutrients such as glucose into
the body's cells.
Researchers believe there is a genetic link. Yet often, as in Maverick's
case, the patient has no family history of the disease.
Though the prognosis is good with early diagnosis and careful adherence
to treatment, people with diabetes are predisposed to complications such as
visual problems and kidney and nerve damage.
In neonatal diabetes, Maverick's type, the pancreas produces insulin but
doesn't release it normally, perhaps because the pancreas is not fully
developed. About one in four babies with the syndrome begins to release
insulin normally after a short time. But one quarter become diabetic again
when they are older. Roughly half of the cases remain diabetic permanently.
There is no cure for juvenile-onset diabetes, though it can be controlled
with daily insulin injections and frequent blood glucose tests. Many people
prefer the pump because it eliminates the need for shots.
The device may actually be advantageous for children because instead of
estimating how much they will eat over the course of the day and calculating
an insulin dose on that basis, their parents can give them more insulin after
a big meal simply by pressing a button, said Dr. Stephen Kemp, the pediatric
endocrinologist who is treating Maverick.
Before Maverick began using the pump, he received five or six shots a day
and his blood glucose level was still too high. Now the needle and catheter
are changed every few days, and one of his parents pricks his heel to test
his blood glucose every few hours.
To prevent Maverick or his 21-month-old brother, Wyatt, from playing with
the buttons, the pump's keypad is locked and his parents control it with a
special key chain.
"There's a mindset that the pump shouldn't be used in children until
they're old enough to do the calculations you need, which is true if the
children are the ones in control of the pump," Kemp said. "But if the parents
are in control, it doesn't matter. We've had very good success with these
2-year-olds [on the pump]."
Wednesday, the doctors at the Little Rock hospital began having success
with scrawny Maverick as well. His blood glucose level remained about 128 all
day. His mother, Bridget, who has been sleeping in the hospital's waiting
room since shortly after he was born, hoped she would get to take him home to
Arkadelphia on Friday.
But a risk, beyond the pump malfunctioning, is that Maverick could get
too much insulin. Blood glucose levels change quickly, rising and falling in
response to food intake, exercise and stress.
Because Maverick is breast-feeding and it is impossible to know exactly
how many calories he eats per day, the doctors must approximate and calculate
his dose based on the length of his feedings.
They overestimated Tuesday night -- something that occurs almost daily
for most diabetics -- and Maverick's blood glucose level slipped to 22. Older
diabetics may become clammy, sleepy, irritable or confused when they are
hypoglycemic, but Maverick showed no signs and nurses caught the problem with
a routine blood check.
If he begins to produce insulin on his own, doctors will taper his dose
and eventually remove the pump. He has gained several ounces -- a good sign
-- and his parents are optimistic.
Bridget Roe quipped that she and her husband, Bryan, will research a name
more carefully before choosing it for their next child: Maverick was named
after a 3-year-old at a day-care center, and the Roes learned later that that
little boy is diabetic, too.
The blue pump, not much smaller than Maverick's head, looks so much like
a beeper that "I just say he's very popular," Bridget Roe said.
That joke may be an indication of his future.
This article was published on Thursday, August 3, 2000
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