Insulin Pumps For Children: When And How To Use One

Insulin Pumps For Children: When And How To Use One

Insulin pumps can improve glycaemic control and allow for more precise and flexible insulin dosing in adults with diabetes, but are they suitable for children?

In this article, we focus on the use of insulin pumps for  children, answering questions such as: can my child have an insulin pump? What are the benefits and disadvantages of using an insulin pump in children? Is there a minimum age that a child must be to get an insulin pump?

Let’s explore the answers below.

What is an insulin pump?

An insulin pump is a small electronic device that delivers rapid-acting insulin to your body as and when it needs it. Depending on the time of pump used, the infusion set or site can stay in place for 2–3 days at a time. 

There are two main types of insulin pumps:

• With tubing, sometimes called a traditional pump or a tethered pump

• Without tubing, also called a ‘patch pump’

The traditional insulin pump delivers insulin through a small catheter (a small tube with a needle) which is inserted under your skin and secured with adhesive. This is often called an ‘infusion set’ or an ‘infusion cannula’.

Plastic tubing connects the infusion set to the pump and delivers the insulin from the pump to your skin.

The ‘patch pump’ does not use tubing and instead sticks right on your skin with the help of a patch. Tubeless patch pumps contain an insulin reservoir. The insulin is delivered through the infusion cannula and the pump can be remote-controlled using wireless technology. 

Insulin pumps deliver insulin in two main ways: 

• A basal rate — a continuous infusion of fast-acting insulin throughout day and night

• Bolus doses — additional, correction doses of insulin given for meals and snacks 

Most insulin pumps have a bolus calculator that works out a recommended bolus dose using the current blood glucose levels, the total grams of carbs consumed and entered by the user, and the remaining insulin from previous bolus doses.

Can my child have an insulin pump?

Insulin pumps can be used in children and adolescents with type 1 diabetes, and may provide many health benefits. However, there are important factors to consider before you decide whether an insulin pump is right for your child. 

Some aspects that parents and caregivers may carefully think about include:

• Is the child willing and motivated to wear the insulin pump? 

• Will the child tolerate the process of setting up the insulin pump, which involves using a catheter and a small needle?

• Does the parent/caregiver fully understand basal-bolus insulin therapy?

• Is the parent/caregiver and/or child or adolescent confident in counting the carbohydrates consumed?

• Does the parent/caregiver know how to operate an insulin pump? 

• Does the parent/caregiver have partnerships with school staff and other caregivers who are willing and able to work with an insulin pump?

• Is the child willing to take several blood glucose tests per day? And is the parents/caregiver willing to help them? (Usually, blood glucose must be tested 4–6 times daily to adjust the bolus doses, make sure the pump is working correctly, and ensure that blood glucose levels are in check)

• Do the child and parent have a team of healthcare professionals available to help and support them through the process of implementing insulin pump therapy?

It is also important to remember that you and your child will have to learn a lot about insulin pumps to be able to use them. 

Starting insulin pump therapy with a specialist healthcare team (including a nurse, a physician, and a dietitian with pump use expertise) is recommended, rather than starting it with a primary care physician (like your GP).

What are the benefits of an insulin pump for children?

There are many advantages to insulin pump use for children, many of which are similar to those of insulin pump therapy for adults:

• Insulin pumps allow for multiple basal insulin rates to be administered and they deliver small doses approximately every 10 minutes. This attempts to mimic the activity of a fully functioning pancreas. Coupled with blood glucose level monitoring manually or with the use of a continuous glucose monitor, they allow for more precise and personalised insulin delivery.

• Insulin pumps can improve glycaemic control and diabetes outcomes and help children lead a more flexible lifestyle [2]. Adjusting insulin doses for exercise or during travel is easier with a pump. Insulin pumps may reduce hypoglycaemia during and after exercise in young people with type 1 diabetes.

• Insulin pumps can make it easier to adjust basal insulin rates in other special circumstances — such as skipping meals, eating less or illness — in a way that is not always possible with injection therapy.

• Bolus insulin doses make it easier and more convenient to control blood glucose levels after eating and to bring down high glucose levels.

• A consistent observation noted following the uptake of insulin pump therapy is a reduction in both the frequency and severity of hypoglycaemia among children and teens with type 1 diabetes. Pump therapy is also associated with a lower rate of hypoglycaemic coma compared with injection therapy, particularly in school-aged children. 

• The risk of diabetic ketoacidosis (DKA) is also lower in young people who use insulin pumps compared with young people who take multiple injection therapy. 

• Studies have shown that families whose children use insulin pumps have an improved quality of life.

What are the disadvantages of an insulin pump for children?

Insulin pump therapy for children may also pose several problems that are highly important to consider:

• Very young children cannot manage their own pumps without help from their parents and caregivers. Older children may also need some help from their parents or caregivers.

• Children may forget to administer insulin boluses after eating; ‘forgetting’ is the most common reason for missing boluses and a significant challenge for kids and teens who use insulin pumps.

• Because kids spend a large chunk of their time at school, school staff may have to be educated in topics such as using insulin pumps, measuring blood glucose, measuring ketones, responding to emergencies, or having to troubleshoot the pump.

• The risk of complications such as ketoacidosis may deter from using insulin pumps. If the insulin pump malfunctions or the infusion set is displaced or clogged, ketoacidosis can occur in 3–4 hours if it is not quickly dealt with. This is because a pump delivers small doses of rapid-acting insulin, so there is no long-acting insulin to fall back on.

• Insulin pump therapy has been associated with weight gain, which may be distressing for teenagers.

• There is a risk of skin infections at the site of the cannula. Infusion-site infections are the most common complication associated with insulin pump therapy, and can cause inflammation, soreness, redness and swelling at the infusion site [5].

• Children and adolescents may dislike feeling tied or ‘tethered’ to their pump.

It is important that you are aware and understand the pros and cons of insulin pump therapy for your child.. Your diabetes care team will be able to help with this. 

What is the minimum age a child can get an insulin pump?

There is currently no internationally defined minimum age that a child can get an insulin pump.

Insulin pumps are often offered to children under the age of seven. Many studies showcase the benefits of using insulin pumps even in very young children, demonstrating improved glycaemic control and a reduction in hypoglycaemia compared to the use of MDI. The advantages that insulin pumps offer in managing unpredictable eating habits and low insulin requirements in very young children, may make insulin pump therapy a good option for lots of young children with type 1 diabetes and their families.

According to clinical guidelines from various diabetes organisations across the world — the American Diabetes Association, the International Society for Pediatric and Adolescent Diabetes, or the Endocrine Society — insulin pump therapy can benefit all individuals with type 1 diabetes ‘regardless of age’. 

It is important to remember that using insulin pumps in different age groups may pose unique challenges. You can discuss the most suitable options for your child with your healthcare team. 

Should your child have an insulin pump?

There are many important things to consider before making the decision about which therapy is right for your child. 

Studies show that pump therapy has many benefits for children with type 1 diabetes, though of course, as with any treatment choice, there are lots that need to be considered and understood before taking on a new therapy. 

Using an insulin pump will require  commitment, and willingness to learn about your therapy.