Insulin pumps

Pediatrics for Parents, Sept, 2003

A normally functioning pancreas continually releases insulin into the blood stream. Through a complex feedback system, more insulin is released when the blood sugar level goes up, and less when the blood sugar level is less.

Diabetes occurs when there's a problem with this system. In type II diabetes (also called adult onset diabetes), the pancreas makes insulin, but the body doesn't respond to it properly and blood sugar levels go up. In type I diabetes (formerly called juvenile onset diabetes), the pancreas loses its ability to produce insulin.

People with type I diabetes require insulin to control their blood sugar levels. With type II diabetes, diet, weight control, and exercise are the first treatment steps. Oral medications are often needed. Some type II diabetics require insulin.

Unlike injectable insulin, insulin pumps give diabetics a steady flow of insulin. The diabetic wears a small pump, about the size of a Walkman. It connects, via a small tube, to a needle that imbedded in the tissue of the diabetics abdomen. The diabetic can adjust the amount of insulin received depending on blood sugar levels.

A recent study evaluated the quality of blood sugar control for 95 children and adolescents on insulin pumps. The diabetics with type I diabetes, ages four to eighteen years old, were all patients at Johns Hopkins Hospital. Their hemoglobin Alc levels (HbA1c), an indicator of blood sugar control over the previous three months, was monitored for six to twelve months before beginning the insulin pump. They were then monitored for 28 months after pump use began.

The average HbA1c levels were significantly lower once the children were on the pump. They have fewer hypoglycemic flow blood sugar) episodes and no increase in hyperglycemia (high blood sugar) or visits to the emergency department for diabetes-related problems.

"Personal behavior is as important as pump use," said Leslie Plotnick, M.D., one of the researchers. "Parental involvement was significantly associated with reduced HbA1c levels, as was blood glucose monitoring at least four times a day."

Insulin pumps, once thought most appropriate for older teens and adults with type I diabetes, work well with younger children who are motivated to control their diabetes.

Diabetes Care, 4/04.