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    Convenient Care: The Insulin Pump

    Insulin pumps deliver a steady stream of insulin, which most closely mimics a natural state, experts say.


    But while the insulin pump is for many people an improvement over multiple daily injections, it requires a dedicated and savvy operator to make it work. The user still has to perform multiple daily blood tests to check for glucose levels, and must know how to program in the right insulin dose after each test; currently available pumps can neither sense current glucose levels nor can they automatically adjust insulin levels.

    "It's just a different tool for delivering insulin; the person still needs to input the doses, and to get the most out of the pump one still has to be pretty knowledgeable and skilled in diabetes self-management. It's not a tool for the novice," Wolpert says.

    "It isn't right for everyone," agrees Michael Freemark, MD, professor of pediatrics and chief of the endocrine and diabetes division at Duke University Medical Center in Durham, N.C. "It requires a strongly committed family and an experienced diabetes team."

    You're Never Too Young...

    Yet with the right supervision and support from dedicated caregivers, even infants or toddlers with type 1 diabetes can benefit from the use of insulin pumps, Freemark tells WebMD.

    "If you have a very conscientious, careful, reliable family who's willing to monitor the use of the pump closely, I think in many ways that pump therapy is more effective in very young children than it is in teenagers who are out on their own and entirely responsible for their care independent of their parents," he says.

    Freemark and colleagues performed a small pilot study of insulin pumps in young children, and found that the pumps reduced the number of episodes of severe hypoglycemia (abnormally low blood sugar) by a factor of five compared with insulin injections. The parents, when interviewed by the researchers, expressed greater confidence in their ability to manage their children's diabetes and a general improvement in the family's quality of life.

    Insulin pumps may be particularly beneficial for children because their unpredictable food intake and energy expenditure make it difficult for parents to judge how much insulin they should give by injection ahead of time. In addition, because their small bodies require only fractions of adult insulin doses, "it's almost impossible to do it accurately through injections. I would venture to say that it isn't possible to administer quarter of half units of insulin accurately by insulin syringes," Freemark says.

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