May 26, 2000 -- Many adults with type 1 diabetes find that insulin pumps -- fanny-pack-type devices that deliver programmed doses of the drug under the skin of the abdomen -- are a discreet, convenient, and effective way to control their blood sugar. But most doctors believe that the devices, which require a good bit of responsibility on the part of the wearer, are not feasible for children who are in school and away from parental supervision during the day.
Now, scientists at the University of Southern California have hit upon what may be an effective solution. In a study of children under 10, they have found that insulin pump therapy used only during the night may be an effective alternative to wearing a pump all the time. The findings are reported in the May issue of Diabetes Care.
While insulin pumps have successfully managed type 1 diabetes for more than 20 years in adults, they are seldom used in young children and adolescents. People who wear the battery-powered pumps must reinsert the catheter used to deliver the drug if it becomes dislodged; calculate what doses of insulin are required by meals, activities, or to correct for an abnormal blood-sugar level; and know when to stop insulin delivery if needed.
Lead researcher Francine Ratner Kaufman, MD, of the University of Southern California School of Medicine, tells WebMD that the study shows insulin pumps don't need to be worn all the time to be effective. "It allows pumps to be used by younger children who might benefit from this treatment," Kaufman says.
But Kaufman also says the insulin pump for young children will stir controversy. "Some pediatric endocrinologists do not think that children less than 10 or 12 are pump candidates under any circumstances," she says.
Well, yes and no. Diabetes expert Alicia Schiffrin, MD, of Jewish General Hospital in Montreal, tells WebMD that although she supports this therapy for patients, it could also be dangerous in the hands of unskilled people when used in young children.
"The success of diabetes therapy in this population does not depend only on the number of insulin injections, the use of pumps, the frequency of blood glucose monitoring, or the access to a diabetes specialist," Schiffrin says. "Both the presence of a stable family environment that is capable of providing support to the patient, and access to a specialized, multidisciplinary health care team that is available for guidance, education, and maintaining motivation also play a role."
Kaufman and her team studied 10 children, ages 7-10. The children either used a nighttime-only pump or received three insulin injections per day. Not only did the children using the pump show improved blood sugar control and fewer episodes of hypoglycemia, or extremely low blood sugar, their quality of life improved because they no longer feared hypoglycemia, the researchers say.
Despite the conflict of opinions that will likely arise, Kaufman says the study results indicate that nighttime pump use, when young children are home and under the supervision of their parents, "is a viable alternative."