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[IP] reply about Rover from "Stephen W. Ponder MD, CDE" <email @ redacted>

Hi Everyone!
This was sent to the list and I believe it is only right and fair for Dr
Ponder to have his input .  Dr. Ponder's comparison to a dog ,in my
opinion, is a good one to show children that just like a pet a pump is as
much responsibility. We live in a throw away society and he did a great
service to teach children not only about the pump but the seriousness of
having one IS just like having a pet it is a serious responsibility.
So below you will read what he sent.
  I have a service dog and he is with me 24/7 and he is a responsibility
and he is teathered to me..I need him as much as I need the pump and I
really believe Dr Ponder has done all of society a wonderful service by the
way he wrote this.
Of course this is my opinion..but then again I also live 24/7 with a
service dog who is worth more than my pump. Children need to learn these
things and if no one will teach them who will?
Kudos to Dr Ponder!
email @ redacted
and thank you Dr  Ponder for sharing this with us.
Please address your comments to the list and to Dr Ponder's email address
which is
email @ redacted

From: email @ redacted

From: "Stephen W. Ponder MD, CDE" <email @ redacted>
Subject: From Dr. Ponder, the vet!
To: email @ redacted
Reply-to: email @ redacted

I'm going to jump into this grilling I seem to be getting with my
comments about my "pet analogy". As a pediatric endocrinologist caring
for children, I often have to use analogies to express otherwise
abstract concepts to kids (not only about diabetes). As a physician, it
is my obligation to provide any patient considering a pump a balanced
view of pump therapy. Most persons that visit this site would be
unlikely not to ask about possible side effects of any new therapy their
physician were to recommend. This is the same with pump therapy. In this
case, the "side effect" I refer to is the inherent responsibility
associted with a pump. NOT that the pump is like a live animal.

I am a firm believer in the pump, starting on it myself in 1983.
Unfortunately, when I started, nobody gave me a balanced view about the
"hassle factor" I had to deal with at the time (changing batteries
daily, uncomfortable infusion sets, how to carry it, etc..) and I went
off the pump for a few years to let technology catch up with my
expectations. I did go back on years ago and would now never go off, but
my endo did not give me that information. I decided to incorporate that
"balance" into my approach to presenting pump therapy to kids. We now
use loaners to allow the child to "try before they buy". I feel more
endos should offer this. Several of my patients tried one of our loaners
(loaded with either saline or with insulin) and chose to hold off. That
begs an interesting question of how many would stay on their pump if
they had the option to return it after a trial period. Clearly, some
would (and do). However, the door to CSII will always remain open to


The new chapter that refers to me in "pumping insulin" is well written.
They authors are well known to me and have outstanding reputations. They
have over 35 years of collective experience in pediatric diabetes and
are leaders in pump therapy for children.

Unfortunately, my "pet analogy" was not presented in it's entirity. I
want youngsters to know that the pump IS a significant responsibility,
which goes hand and hand with being able to take insulin on demand and
vary your daily schedule. Many children DO relate to the concept of the
favorite family pet. I ask them to contemplate if they were "attached"
to their favorite pet by a leash, but had to take the pet everywhere
they went (to church, school, out to eat, etc..). Despite how loved and
valued the pet might be, one might begin to grow weary of the proximity.
When I use this, most kids chuckle and will get the point. The point
being that much responsibility comes along with the wonderful benefits.
It has served me well and I'm sorry it has been mis-interpreted. I have
a large pumper population that grows weekly. I will continue to forward
pump therapy, and in a balanced way.

My concern now is the need for higher standards for training children on
pumps. I agree with all of you that children are too often treated like
little adults. I advocate teaching problem solving skills to my
patients, plus several sessions of pre and post pump start education
targeting troubleshooting skills and carb counting. A couple of hours of
button pushing training and a few videos by a certified pump trainer
with minimal to no pediatric experience is just not good enough. I want
all my pumpers to stay on their pumps until we have a cure. I would
welcome a concerted effort to advocate improved methods and standards
for training the patient starting on the pump, including follow up
education to review how well basic concepts are used and how well
problems are dealt with. We use this approach in our center.

We are all in this together.

Steve Ponder MD, CDE

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