Insulin pump therapy in Type 1 pediatric patients: Now and into the year 2000

There are a number of medical conditions such as growth failure in children , pregnancy, lipid abnormalities, and early complications that are improved by the meticulous glycemic control that can be achieved with insulin pump therapy (CSII). By using an insulin pump, many patients with severe hypogly cemia, the dawn phenomenon, extremes of glycemic excursion, recurrent diabe tic ketoacidosis (DKA) and hypoglycemia unawareness have amelioration of th ese problems. However, pump therapy involves problems such as weight gain, recurrent ketosis due to pump failure, infections, and risk of hypoglycemia . Owing to many developmental issues, young children may not be able to wear the pump without parental supervision. We have used the pump at night time only in these patients. This has allowed children of 7-10 years of age to b enefit from improved nocturnal glycemia without the risk of pump therapy wh en they are without an adult to help. We have also used the pump in subject s with recurrent DKA and in our general patient population (mean age 13.6 /- 3.9 years). In our pump cohort, CSII led to improvement in quality of Li fe, knowledge, adherence, and responsibility. A reduction in hypoglycemia, DKA rate and mean HbA(1c) was associated with pump usage. For this to occur , however, pump education must be geared to the pediatric subject and his/h er family. Education materials and tools help in learning how to use the pu mp and how to deal with the intricacies of basal and bolus dosing, and the effect of exercise, food and illness on diabetes management. The pump has improved since it was first introduced and these modifications have made it easier, more painless and less hazardous. With the developmen t of continuous glucose sensors and implantable pumps, the next century wil l see pump therapy lead to the artificial pancreas. Copyright (C) 1999 John Wiley & Sons, Ltd.