Tips for Using the Pump and Continuous Glucose Monitor in Young Children
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
- Use a logbook to keep track of as much information about your child's daily activities, food patterns and insulin dosages as possible.
- The more information you have captured, the more you can learn about the effect of exercise, the composition of meals and if your correction dose and basal and bolus doses of insulin are optimal.
- Use the MiniMed monitor during the usual week and on one weekend or holiday to record any differences between usual and special occasions.
- Be sure to secure the device, particularly the wire connecting the monitor to the sensor, or it will be pulled out during activities.
- Involve your child with what is happening and tell her or him about the results.
- Use the MiniMed monitor as an indication of how your child might do with an insulin pump since the insertion and wearing of the catheter is similar to wearing a pump.
- After you have made changes in your child's diabetes regimen, think about using the MiniMed monitor again to determine if these changes were beneficial.
Tips for the Parents of Young Children Using an Insulin Pump
- Give the meal-time bolus as the meal is being eaten, or just after it has been completed. This way the administration of insulin can be matched with what your child consumes, rather than what it is anticipated that he/she will eat. We recommend using rapid-acting analogues in the pump, such as Novolog or Humalog.
- Use the Silouhette or Tender catheter that is inserted at a 33- to 45-degree angle rather than the straight (soft-set)-it functions better in those with little fat.
- Place the catheter in the upper hip or backside rather than the abdomen.
- Use a secure, well-fitting belt device to hold the pump.
- Empower your child to give simple answers to questions about the pump.
- Monitor the blood-glucose level often-at least four to six times per day-and correct abnormal blood-sugar levels.
- Check for ketones, either in the blood or urine, when the blood glucose has been elevated for three to four hours beyond your child's target range.
- Don't put your child to sleep with an elevated blood-glucose level until you are assured that it has been corrected. An elevated blood-sugar level could be an indication that the delivery of insulin is not occurring.
- Be sure your child remains comfortable with using the pump. Praise him or her for doing a good job, and do not put value judgments on glucose levels. Appreciate the advantages that the pump has to offer.
- Be prepared to give disconnection doses when it is in your child's best interest not to wear the pump.