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[IP] Abstract on pumps - I don't agree with some of this

1 : Diabetes Metab Res Rev 1999 Sep;15(5):338-352Related Articles, 
Books, LinkOut 
Insulin pump therapy in Type 1 pediatric patients: now and into the year 
Kaufman FR, Halvorson M, Miller D, Mackenzie M, Fisher LK, 
Pitukcheewanont P 
Division of Endocrinology and Metabolism, Childrens Hospital, Los 
Angeles, and Department of Pediatrics, University of Southern California 
School of Medicine, Los Angeles, California, USA.
[Record supplied by publisher]
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 
benefit 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 13.6+/-3.9 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 first introduced and these modifications 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 artificial pancreas. Copyright 1999 
John Wiley & Sons, Ltd.
PMID: 10585620 
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