Choosing the Best Technology to Manage Your Child’s Diabetes

“Oh, they wear an insulin pump? That must mean their diabetes is really bad, huh?”

“My aunt’s cousin’s friend’s daughter has an artificial pancreas! Have you heard of that?”

These are a couple of well-meaning questions I have been asked recently when people find out that I am a nurse practitioner working with children who have type 1 or 2 diabetes. Many questions relate to diabetes technology, but the needs of every patient are different.

By reviewing this quick recap on technology advances in diabetes management, you can be better prepared to decide what will work best for your child and your family. The ultimate goal is to find a cure for diabetes.  Until then, available technology can help lessen the burden and allow diabetes to fit more easily into a family’s lifestyle.

Insulin Pumps

An insulin pump is an advanced option for delivering insulin. It is important to ensure safety criteria are met through extensive training for the family before starting an insulin pump.

Insulin pumps deliver insulin continuously throughout the day (basal or background insulin) and larger amounts of insulin (bolus) given to cover carbs at meals or correct high blood glucose (sugar) levels. The insulin goes into the body through a small catheter placed under the skin. The first pump was about the size of a microwave! Now they are very discreet and come in all shapes and sizes.

Most pumps use thin tubing to deliver insulin to the infusion site in the skin, but there is also a tubeless option.  The site changes are done at home every three days.

When Is an Insulin Pump a Good Option for a Child?

• Insulin pumps are safe and effective for children of all ages - even infants and toddlers!
• Pumps can be helpful for children with who are afraid of needles.
• A pump can be set with multiple different rates to match the child’s insulin needs at different times of day.
• An insulin pump requires a strong knowledge base for any patient or parent managing it (consistent blood glucose checks, staying in touch with your child’s endocrinology team, pattern management, etc.).

Continuous Glucose Monitors

Continuous glucose monitors (CGMs) measure interstitial (fluid between cells) glucose through a tiny sensor inserted under the skin and allow for more real time tracking of blood glucose levels. Some have alerts and alarms for when the blood glucose is predicted to go too low or high, allowing a person to take action to prevent this. CGMs can be used along with an insulin pump or on their own for a patient taking injections.

When Is CGM a Good Option for a Child?

• CGM may help put families at ease by alerting levels that are too high or too low, causing less worry throughout the day or night.
• If a child is looking for more independence, CGM’s allow caregivers to identify patterns and even remotely monitor blood glucoses while kids are at school or at a friend’s house.
• On the other hand, sometimes seeing all of your child’s blood glucose results all throughout the day and night can cause anxiety. It can be difficult to balance managing diabetes while also letting “kids be kids”.

Combined Pump and CGM Systems

There are now insulin pumps and CGMs that work together to help a person optimize diabetes control. These still require input from the patient.  Patients are the brains behind the operation!

Some pumps can give “micro-boluses” to bring blood glucose down when the sensor reading is trending high, or pause insulin delivery if there is low blood glucose. This is called artificial pancreas or closed loop technology, but is not an actual “fake” pancreas as people may assume from the wording. As of now, the pump and the sensor are still separate devices worn on 2 different sites on the patient’s body. This is a rapidly changing area in the diabetes world and new advances are occurring frequently.

Some patients worry about what others will think if they see them wearing a diabetes device. This is a very personal choice. Pumps and CGMs can be worn discreetly or more visibly. Sometimes wearing a pump can be an easy way to meet other people in the diabetes community! There have been Olympians, Miss America contestants, musicians and many others who benefit from wearing diabetes technology.

All devices have pros and cons and it is important to make an informed decision with your family and your care provider as to which type will best fit your child’s needs. Technology availability is dependent on each patient’s insurance provider. Your child’s care team will work with you to find the best solution based on coverage and medical need.

For more resources and information on managing diabetes, click here.