A Pediatric Endocrinologist Comments

"I have over 200 children pumping insulin in my practice now. I think pumping is as superior to shots as blood glucose monitoring is to testing urine glucose with clinitest tablets."

I'm a pediatric endocrinologist. I have seen more consistent positive results from pumping Humalog that any other single change that I know of. For me, I think putting Humalog in an insulin pump is the best advice I've been able to give since I finished my training in 1983.  The children on the pump and their parents are almost always amazed at how well it works. Kids who have high blood sugars pour those calories out in the urine. Their brains know the calories are leaving the body and wants to replace them, so the kids are hungry all the time. So they eat. The blood sugars then stay high. It's like a mosquito bite...the more you scratch it, the more it itches. When the blood sugars are held in check for a period of time, possible with pumping Humalog, the brain wises up and the hunger disappears. When you're not hungry all the time, you feel better. I used to only use pumps in children who were getting sick all the time. I've changed my mind about that.

Lots of kids look at their blood sugars like grades. When they see a high one, they feel like they just got a D on a math test. Blood sugars, or hemoglobin A1c levels for that matter, aren't grades, they're more like numbers on a speedometer. Children, particularly young teenagers, hate to see high blood sugars...so they don't like to test them. Their high blood sugars are, in and of themselves, a disincentive to checking them. When they are pumping Humalog, they're likely to see target blood sugars when they test, and my experience is that I see them checking more. You check more, you make appropriate changes more and your control is better. For this reason, I think that the pump should be considered even in kids who refuse to test their blood sugars. It frequently breaks the cycle of pain. Me, I'm a believer.

The pump takes a high level of motivation. I liken the difference between the pump and shots to a car and a bicycle. The former is vastly superior to the other, but the potential for danger is also greater. I have had to take some kids off the pump who won't check their blood sugars, change their sites appropriately, or won't follow the rules of the road. Drivers usually cause accidents, I say, not the cars they're driving. If the people running the pump aren't responsible enough to stay safe, it's better their "license" is suspended for awhile. It isn't for everybody.

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