Insulin Pumps for Children: What You Need to Know

Insulin pumps for children are a great option for diabetes management as long as the children and/or their caregivers can safely use them (1). If you aren’t sure what an insulin pump is or how it works, start with reading my other article, Diabetes Insulin Pump: A Complete Guide to Getting Started.

As someone who has lived with type 1 diabetes for 17 years, I can confidently say using an insulin pump has changed my life for the better. I wrote this article because I know my experience alone shouldn’t sway someone’s decision in choosing pump therapy for diabetes management, especially when we’re talking about kiddos.

In this article, we will cover the signs that indicate pump therapy would be a good option for your child, benefits and drawbacks of insulin pumps for children, and other things to consider before getting a pump.

***This article is for general informational and educational purposes only and is not intended to treat, cure, or diagnose any disease. The information in this article is not a substitute for medical care or advice provided by your healthcare team. Please consult your doctor or dietitian for specific, personalized treatment.***

Signs that indicate an insulin pump would be beneficial

Insulin pumps are the current treatment of choice for more than 25% of patients with diabetes (2). Children living with diabetes are especially good candidates for pump therapy if they have any of the following:

• High Hemoglobin A1c
• Poor blood sugar control
• Frequent hypoglycemia (low bloodf sugar) especially overnight or during activity
• Frequent diabetic ketoacidosis (DKA) episodes and hospitalizations
• Gastroparesis (disease where the stomach cannot empty itself of food as well)
• Cannot give themselves insulin injections due to age
• They have a need for more flexibility with their diabetes care

Benefits of insulin pumps for children

Insulin pumps are designed to improve the quality of life of those living with diabetes. They allow for more flexibility in everyday life, less math calculations, and improved blood sugars.

Flexibility with insulin delivery

Children’s appetites and activities can oftentimes be all over the place. Using an insulin pump ensures insulin can be given any time or anywhere, as the device is always attached to your child.

The pump can also deliver insulin in much smaller doses than an insulin pen or syringe can which is beneficial for insulin-sensitive children or those newly diagnosed and going through the honeymoon phase (2).

And finally, basal insulin delivery can be customized to give different amounts at different times of the day versus getting the same amount of long-acting insulin over 24 hours when on injections.

This allows for more stable blood sugars as insulin needs change based on activity, puberty, hormonal changes, stress, sickness, vacation, and more.

Bolus calculations

How often are you having to do calculations such as how many carbs your child is eating and figuring out how much insulin to give?

When you or a loved one has diabetes, chances are you end up being pretty good at math. With an insulin pump, when your child enters in the amount of carbs he’s eating, the pump automatically calculates the proper insulin dose based upon the current insulin-to-carb ratio, insulin on board, and blood sugar target.

Less severe hypoglycemia

Since fast-acting insulin remains active in the body for up to 4 hours, a child’s risk for hypoglycemia goes up if more injections are taken within that time frame to correct a high blood sugar for example. Insulin pumps use an algorithm that takes into account current blood sugars and any active insulin in the body when calculating food or correction boluses. This lessens the chance of severe hypoglycemia from over bolusing.

Less hypoglycemia overnight

Nowadays, most insulin pumps work with a continuous glucose monitor (CGM) to predict future blood sugars and will automatically adjust basal insulin delivery to keep blood sugars in target.

This is especially wonderful overnight when your kiddo is trying to sleep. If the pump senses your child’s blood sugar is going too low, it will automatically decrease or stop basal insulin delivery. On the flip side, if blood sugar is going too high, it will increase basal insulin delivery.

Yay for better sleep for everyone!

Technology advancements

Due to insulin pump technology, your child’s experience and satisfaction with managing his diabetes may improve.

Most pumps can link to a phone or cloud-based technology so that your child’s diabetes provider can see blood sugars and pump settings remotely. This helps with better diabetes care as most insulin pump reports show overall blood sugar trends and where adjustments may be needed.

Possible drawbacks of insulin pumps for children

With all the benefits an insulin pump can provide, there are a few potential drawbacks to consider.

Sites falling off during activity

Contact sports, such as football, wrestling, and hockey may increase the chances of the pump site falling off or coming dislodged. For this reason, bringing a couple extra sets of supplies with you when leaving the house is always a good idea.

Some children take the pump off during activity (if the pump isn’t directly attached to the body) while others leave it on. It is safe to take the pump off for one hour. After that, have your child check their blood sugar and reconnect to deliver a correction bolus if needed and/or eat food. Then, your child can go back to the activity.

Constant reminder of having diabetes

While it’s nice not to have to pack insulin and needles when leaving the house, having something attached to you nearly 24/7 can sometimes be exhausting.

Alerts and/or alarms coming from the pump will also become part of the daily routine as well. These alerts will happen when the pump is low on insulin, the battery needs changing or recharged, or when a blood sugar is too low or high to name a few.

Alerts can typically be set at a certain volume or to vibrate but alarms will always make a sound. As a pump wearer myself, I personally have all my alerts set to vibrate while others I know have theirs set to ‘sound’.

It just depends on the person and/or the type of pump one has. For myself, I felt setting the alerts to vibrate would be more discreet and still allowed me to know if anything was wrong with the pump or my blood sugar. In a young child, alerts set to ‘sound’ may be optimal so caregivers can hear it and assist if needed. Ultimately, you and your child have to decide what is best.

Potential complications

A final thought on potential drawbacks to pump therapy involves the risk of rapid DKA development. This can happen as the pump only uses fast-acting insulin. If there is a disruption in insulin delivery from pump failure, air in the tubing, a damaged infusion set, or infection at the insertion site, there is no long-acting insulin on board for back up (2).

Longer time to set up

Initially, it may seem like it takes forever to set up the insulin pump and change the site every 2-3 days. Compared to insulin pens or vials and syringes, it does take a bit longer to change out insulin pump supplies. As long as your child is motivated to continue using the pump, this process does and will get easier!

Things to consider before getting a pump

Some final considerations before going through with an insulin pump involve comparing which insulin delivery method is best for your child, understanding there are multiple steps in getting a pump, and that pump therapy doesn’t have to be permanent.

Insulin pumps vs injections

While there haven’t been many studies comparing which insulin delivery method is best (injections or pumps), the studies that have been done show insulin pumps are slightly better at lowering hemoglobin A1c and reducing severe hypoglycemia episodes (3). For a different perspective on pumps vs. injections, read Christel Oerum’s article over at Diabetes Strong for why she chooses to use injections.

If you’re struggling with the decision on which method is best for your child, resources like DiabetesWise and the PANTHER Program can help. They provide websites to help people with diabetes decide which diabetes device is best for them.

Multiple steps to getting a pump

Once you and your child decide an insulin pump is best, some next steps include:

• Meeting with your child’s healthcare provider or diabetes educator to assess readiness and motivation.
• Deciding which brand of pump to use.
• Determining the cost of the insulin pump, refills on supplies, and any additional accessories or skin preparation items.
• Meeting with an insulin pump trainer to go over settings, how to use the pump, potential complications, and more. This first meeting will likely last 2-3 hours and will include a follow up or two with the pump trainer.
• Creating/updating instructions for insulin pump use in your child’s diabetes medical management plan (DMMP) for school or daycare. Check out diabetes.org/safeatschool for training materials and a DMMP template.
• Educating family members or other caregivers on basic insulin pump use.

Wearing an insulin pump is not permanent

An insulin pump is not a permanent decision like a tattoo for instance. Know that your child can decide to go off the pump and return to multiple daily injections for various reasons. For example, some children go off the pump during summer break and go back on it when school starts.

Other reasons pump therapy may be stopped include cost, a child’s dislike for the pump, issues with wearing it, blood sugars that remain out of control, or mood disorders (3).

Final thoughts

We all want what’s best for our kids, especially if they have a chronic illness like diabetes. From the studies that have been done, insulin pumps trump multiple daily injections when it comes to diabetes related outcomes.

If you and your child do agree that an insulin pump would be best, know that it won’t do everything. It doesn’t know what or how much your child is eating, so understanding carb counting is a big piece to successful pump therapy.

So, if you and your child are motivated, ready to learn, and have considered pump therapy benefits and drawbacks and are ready to dive in, reach out to your child’s diabetes provider to get started.

Need help with carb counting?

Download my free nutrition handout to get started with the basics of diabetes nutrition.