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Kurt hates shots. Since he was diagnosed with type 1 diabetes at the age of 4, my wife and I administered all of his shots, whether he was at home, school or a slumber party. Kurt seemed unusually sensitive to pain. Although Kurt was intelligent enough to draw them up, count carbs and appropriately suggest how to treat highs and lows, he refused to do the shots himself.
We described our frustrations to our physician, who suggested that we try an insulin pump. Although we consider ourselves open to new technologies, we were tentative because so many other clinicians discouraged the use of a pump by a 9-year-old. Most people told us that a child had to be capable of independently administering his own insulin shots before he was a suitable pump candidate.
Despite all of this guidance, the pump made sense to us. The biggest attraction was that we would only have to do one insertion every three or four days. Furthermore, Kurt would not have to come home from a San Diego Padres game with his blood sugar over 300. Kurt could now be late for lunch or snacks, or skip them entirely. It actually seemed feasible that Mom and Dad could get the weekend alone. The biggest factor, however, was that Kurt asked for the pump frequently, especially after painful shots.
We decided to give the pump a try, but then doubts set in. How could we trust a 9-year-old boy to manage a $4000 medical device 24 hours everyday? He could over-infuse, under-infuse, break the pump or even lose it. He may bring it to school and, after one snide comment from a classmate, he might refuse to wear it again.
Kurt's first insertion was tough, but once he hooked it up, there was an enormous sense of freedom in that there would be no more shots for the rest of the week.
Control did not happen right away. Figuring basal rates, counting carbs and remembering the bolus was tough. We came close to returning it because the numbers were not improving, but Kurt wasn't going to give it up yet. He convinced us not to quit, and learned how to operate the pump.
After two long weeks, Kurt was in better control than he was before the pump. During his third week, I was scrolling the glucose meter's memory, which showed the last two day's results: not one blood sugar reading above 160. We figured out how to change the site without any discomfort, and forgot about shots entirely.
Kurt still gets highs now and then, but only when we incorrectly prime the tubing or forget to bolus. He returns to control range quickly with the pump. He has not had one bad low since he started using the pump, while he used to have them at least once every month.
After four months, we are convinced that the pump is appropriate for kids who are willing to operate and maintain it. Kurt's control is far better than it use to be.
As Kurt's parents, my wife and I can now focus more on parenting instead of worrying about the activity of long-acting insulin. Kurt says that he is never going back to needles.
0 comments - Feb 1, 1999
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