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Many new technologies have recently become available to help manage type 1 diabetes. Among these, insulin pumps and continuous glucose monitors are proving to have great benefit, even in young children.
In preschool and early-school-aged children, these innovations often require unique approaches, added vigilance and appropriate patient selection. At Children's Hospital in Los Angeles, we have had the opportunity to use these technologies to determine how they can best help our youngest children with type 1.
Insulin Pumps Improve BG Control, but Require Discipline
Young children can experience the full benefit of insulin-pump therapy if they are appropriately selected, educated and supported by a diabetes health-care team. An insulin pump can be used to improve blood-glucose control and decrease episodes of low blood sugar.
In our center, this has been done without adversely affecting the quality of life of our patients and their families. The selection criteria are based on the child and family having the appropriate attitude, skills and knowledge to benefit from this advanced, yet utilizable, technology. The child and/or parents must understand how to correct abnormal blood-glucose levels and carbohydrate count and adjust for changes in daily routine. They must be aware of how to manage the pump during illness and they must have around-the-clock access to a diabetes health-care team expert in pump management. The child must have worn the pump catheter to be sure that there is a clear understanding of what wearing an insulin pump entails.
Most importantly, there must be a way to ensure that use of the pump can be appropriately monitored when the young child is in school or day care and away from a parent. There must be a responsible adult in these settings or else the pump cannot be worn at those times.
Continuous Glucose Monitoring Ideal for Tracking BG Patterns
Young children can also use the continuous glucose monitoring system that is currently available by MiniMed. The information obtained with the MiniMed monitor can be helpful in determining problems with glucose control, particularly in detecting nighttime low-glucose episodes.
We have used this system in children as young as one to two years of age. It measures the glucose content in the subcutaneous tissue every five minutes by placing a small catheter containing the sensing electrode under the skin. It stays in place for up to three days and the information stored in the monitor can be downloaded at the doctor's office. Graphs of the daily glucose levels can then be printed. You go over the graphs with your health-care team to find patterns of abnormal-either high or low-glucose levels and determine how to correct them.
The MiniMed monitor is available to children at participating doctor's offices.
GlucoWatch Will Give Parents a Good Night's Rest
Later this year or in early 2002, the GlucoWatch Monitor by Cygnus of Redwood City, California, will be available. Unfortunately, this device will not initially be approved for use in children, but there is no doubt that it should have a tremendous benefit in diabetes management.
While the GlucoWatch will be worn by adults, teens and older children on the arm, young children will likely place it on their legs. It might enable parents to finally sleep through the night knowing that if abnormal glucose levels develop, an alarm will wake them in time to correct the situation and avoid the immediate consequences of extreme highs and lows.
According to Craig Carlson, vice president of Cygnus, clinical data from studies using the GlucoWatch Biographer on children ages seven to 17 are expected to be submitted to the FDA by then end of this year. Approval is expected by the first half of 2002, and the Biographer should be available to kids in late 2002 or early 2003.
More to Come
In the coming years, there will be more innovations and novel devices to aid us all in managing diabetes. Health care professionals, parents and children with diabetes will need to be partners in working together to best determine how to use these breakthroughs to the benefit of us all.
Francine Ratner Kaufman, MD, is professor of pediatrics at Keck School of Medicine at the University of Southern California and head of the division of endocrinology and metabolism at Children's Hospital in Los Angeles.
Mary Halvorson, RN, MSN, C.D.E, is an administrator with the division of endocrinology and metabolism at Children's Hospital in Los Angeles.
Tips for Families of Young Children Using the MiniMed Monitor
Tips for the Parents of Young Children Using an Insulin Pump
0 comments - Jun 1, 2001
Diabetes Health is the essential resource for people living with diabetes- both newly diagnosed and experienced as well as the professionals who care for them. We provide balanced expert news and information on living healthfully with diabetes. Each issue includes cutting-edge editorial coverage of new products, research, treatment options, and meaningful lifestyle issues.