Using an insulin pump takes special training and a commitment to overseeing its safe use. But with the right guidance, I think it can be safely used by more people -- including those classified as "at-risk" and "hard to serve" populations. (By saying "high risk" I'm referring to existing classifications of predominantly low income, urban populations with limited resources).
I've seen articles extolling the benefits of pump use for adults and, more recently, for children. One similar theme in these articles is the person's commitment to pumping: their "readiness," "willingness," and (though not stated this way) their "qualifications." The most common selection criteria medical centers desire for insulin pump therapy are: high motivation with family support, willingness to do four to seven blood glucose tests a day and log the results, accurate and consistent carb counting and a good relationship with medical staff.
I have yet to see a study or article about what supports could be put in place to make pumping more accessible and available to those deemed "higher risk" patients (please let me know if you see such a study!).
Is the pump necessarily an advanced concept, and is there a way to create beginner pumping that is user-friendly to a "high risk" population? Diabetes is complicated at diagnosis, especially Type 1 diabetes when insulin becomes an immediate part of daily life, but information is introduced to all beginners slowly so that they can take care of themselves. More advanced concepts may be taught later.
I'll be on the lookout for anyone doing research in that area. In the meantime I hope to see information about pumps, continuous glucose monitors and treatments like symlin reach the widest possible audience.
I was shocked when we lived in an urban area and I met a 10-year-old boy who was two years older than my son and had had diabetes for about four years. He didn't know what Josh's insulin pump was. From what I understand, he did keep his endocrine appointments at a local hospital, and I don't know what his A1C was, but I was bothered that he knew nothing about insulin pumps. Why didn't he have this information?
At another event I met a father who was lamenting how hard it was to feed his young daughter and how she couldn't eat the familiar family foods because she was on two shots a day of NPH and regular. My child of about the same age was on lantus and novolog and eating much more freely than this gentleman's young daughter. And I was at the seminar to learn about pumps! This father left the one-day seminar armed with new information and new possible treatments to discuss at his child's next endocrine appointment. But again I was troubled -- why weren't the options presented to him in the doctor's office?
Research and a proactive stance with doctors opens doors for my son's treatment. But I'm not comfortable that many families don't get the information and aren't offered newer treatments. It's a public health issue to get the information out there. And I believe it's a public health issue to find ways to make the full menu of treatment options (including insulin pumps and continuous glucose monitor) accessible to all children living with diabetes.
Most public libraries have free Internet service, so health information can be accessed. Free educational seminars sponsored by groups like the ADA and JDRF, and by local hospitals, are another valuable tool. I applaud Children with Diabetes for offering scholarships to their very informative conferences.
But bottom line, health care providers need to look beyond the limited definition of who is "pump ready" and instead consider the steps to facilitate pump readiness even among the "hard to serve". It may mean longer appointments and increased reimbursements by Medicaid, Medicare and the insurance industry.
Published On: July 25, 2007