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I am 12 years old, and I am interested in an insulin pump because my 
blood glucoses have been 200-300+ at breakfast in the morning, and 
150-250 for dinner. (My range is 80-180.) My parents don't know what to 
do because if we change anything, my glucose is about 30-40 in the 
middle of the night, and for dinner, if I reduce my lunch, I have to get 
snacks about every two hours. What should we do? 


It's not an easy task to answer your question specifically by e-mail. 
First of all, it would be important to know your daily insulin doses and 
see if you're already on a proper intensified regimen (for example, 
Regular before meals, eventually added with NPH at breakfast and/or 
lunch, plus Regular before supper and NPH at bedtime as well as the 
correct timing of your insulin injection) that could assure you a better 
fasting blood sugar avoiding lows during the first half of the night. 

Only if such a regimen, properly applied, doesn't work, then I'd advise 
the pump to an adolescent: in fact it takes a lot of motivation and of 
education, and quite a lot of coaching from your diabetes team, to learn 
the new and complex program associated with an insulin pump. 

I think that if you and your family have already achieved the most 
important factors (education and motivation), you should be able to 
control your daily blood sugar shifts on subcutaneous insulin therapy 
without the need of a pump. And if not, you should now concentrate on 
them before any new device such as a pump is considered. 

In any case, you'd better discuss how to find the best way to treat your 
diabetes with your diabetes team. 


Additional comments from Dr. Quick:

Dr. Songini doesn't sound too excited about using a pump in your 
situation. Neither do I. Starting an insulin pump is a very complicated 
decision for anyone to make, let alone a 12 year old, and the factors 
that I consider important before anyone makes a final decision include 
much more than just correcting a single problem with blood sugar 
control. Other factors include the level of your desire to "take 
control" of your diabetes, your need for more flexibility in insulin 
delivery to match a variable lifestyle, your willingness to live with a 
device 24 hours a day, your willingness to check at least 4 blood sugars 
daily, and much, much more: for instance, do you have a doctor and 
diabetes team who are familiar with using pumps in young adolescents? 
Who's going to pay for the pump? What do your parents think of pumps? 
Are you an independent-minded individual who's willing to experiment? Do 
you like mechanical gadgets? 
Basically, there are many possible ways to give insulin by shots to deal 
with your present problem, and until they are all tried, it's difficult 
to visualize that starting an insulin pump would be any easier. A pump 
is appropriate part of diabetes therapy for some kids your age, but only 
after long consideration of all the factors involved. 


Original posting 30 Sep 1998
Posted to Medications: Insulin Pumps

Insulin-Pumpers website http://www.bizsystems.com/Diabetes/