Insulin pump therapy from the time of diagnosis of type 1 diabetes.

[Ellen]

Insulin pump therapy from the time of diagnosis of type 1 diabetes.

Diabetes Technol Ther. 2006 Dec;8(6):663-70. Links
Insulin pump therapy from the time of diagnosis of type 1 diabetes.Ramchandani N, Ten S, Anhalt H, Sinha S, Ching J, Finkelstein A, Maclaren NK.
Department of Pediatrics, Maimonides Medical Center/Infants and Children's Hospital of Brooklyn, Brooklyn, New York 11219, USA. nramchandani@maimonidesmed.org

BACKGROUND: This study was designed to test the feasibility and efficacy of continuous subcutaneous insulin infusion (CSII) being instituted within 1 month of diagnosis of type 1 diabetes mellitus (T1DM). METHODS: Twenty-eight consecutive patients with newly diagnosed T1DM with a mean age of 12.1 +/- 6.2 years were placed on CSII, as early as within 1 day of their diagnosis. All accepted CSII when offered it, and none elected to discontinue CSII after follow-up periods of up to 3 years. RESULTS: Hemoglobin A1c levels declined from an initial mean of 10.5 +/- 2.4% to between 6.5% and 7.4% over the next 18 months, at a mean insulin requirement of 0.33 units/kg/day at 3 months, which gradually rose to 0.58 units/kg/day by 18 months. Endogenous insulin secretion, measured by C-peptide values, remained stable during the first 12 months after diagnosis. There was no significant weight gain for the duration of the study (20.7 kg/m(2) vs. a peak of 22.1 kg/m(2) at 12 months, P = 0.54). CONCLUSIONS: The study provided a positive experience with CSII as the initial insulin replacement therapy in newly diagnosed patients with T1DM with excellent clinical outcomes and apparent prolongations of the honeymoon period. It remains to be proven by random patient assignment whether endogenous insulin secretion is better preserved with CSII as an initial ongoing treatment modality and whether long-term complications are reduced by this approach.

PMID: 17109598 [PubMed - in process]

[Mom2rh]

Here's to insulin pump therapy becoming standard tx at dx!

[Mama2H]

Ellen, can you tell me where you found this so I can take it to our Endo (anti-pump :( ) When we go back in Febuary? I would appreciate it :D

[Twinklet]

Ellen, can you tell me where you found this so I can take it to our Endo (anti-pump :( ) When we go back in Febuary? I would appreciate it :D

Why is your Endo anti-pump? If your daughter wants a pump, I'd find another Endo, pronto. While the first month was extremely difficult for us, it is WAY better than shots.

[Ellen]

Ellen, can you tell me where you found this so I can take it to our Endo (anti-pump :( ) When we go back in Febuary? I would appreciate it :D

Entrez-pubmed is a great place to search for new abstracts - if you're looking for articles on pump therapy you can use the search term CSII (continuous subcutaneous insulin infusion) - so try searching CSII and Children if you want more info to share with your endo.

Is your endo anti-pump all around? If so, I'd look for one who is open to all treatment options. Pump therapy is not new.

I found it at entrez-pubmed http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed


but you can access the abstract here:

http://www.liebertonline.com/toc/dia/8/6

Specifically here

http://www.liebertonline.com/doi/abs/10.1089/dia.2006.8.663

[Mama2H]

Thank you!

Our Endo does not want Hailey on the pump until she has been dx one year and is certain the honeymoon is over :( We argued with her a bit about it and she agreed to re-evaluate at the Feb appt. If she will not work with us at this appt we are planning to go to a different Endo. We feel she is more used to talking than listening and was upset that we had "plans" of our own. We want a team member not a "boss" kwim....

[mischloss]

Hi Mama,

I can see the doctor's side that with the honeymoon period, there is a great deal of instability regarding what the body is still producing and not producing. Initially, we were opposite in our approach. I was offered the pump while my son was still in the hospital. Our endo's timeframe was about 3-4 months after diagnosis, just to see that the bg's are leveling off and that honeymoon is winding down. I actually was against the pump because of it being visible on my son and him then being "different" looking at school. I was of the opinion that he take his shots and then go on with life and not have to be tethered. Of course I am converted now that he has been pumping since Sept! :o

But regarding your Doc. It sounds like more of a personality issue then a pump issue and if you are not confortable or "allowed" to have an opinion other than what your doctor is offering to you, then it is time to shop around for another Endo. You want open communication with your doctor's and not to be "talked down to" which I would not tolerate. The care of your child is a group effort...based on doctor's input, the child's needs and the families needs as well. What the right fit for your family may be, my NOT necessarily be for everyone and your doctor should be open to it.

[jeep_bluetj]

Why would honeymoon have anything to do with it? Why would ANY endo be anti-pump?

NPH (seemingly standard treatment) is the absolute WORST for honeymooning. Once it's injected, you got 4 hours before the trainwreck. Or maybe 5 or 3 hours, who knows. And if some insulin comes naturally, well, too bad - because the train's still on the way.

At least with a pump you can adjust all the time.

The ONLY thing I can agree with is that NPH/R is "easier" - Inject "this much". eat "this much". Check 4 times a day. Call us every week. Don't do anything else. And that's true. And it'll work OK that way. And I'm sure that there's a percentage of folks that like it that way. But not those that find CWD.

I'd much rather carbcount and do the math. Heck, the pump will do the math for you.

[Mama2H]

Sorry to hijack your thread Ellen :cwds: Thank you for the links, I am wading through them :D

We are doing Humalog and Lantus and already carb counting. You made the exact point that I was trying to make to the endo. The one day that Hailey started kicking out insulin we had to constantly feed the insulin since she had Lantis on board, if we had the pump we could turn down the basal right now and see results in a few hours instead of trying to adjust the Lantus DAYS from the start only to spend a weeks trying to get the correct dosage instead of days. We are suppose to do all adjustments on our own and call them after we have made 3 adjustments. Today I am emailing her numbers since they are insisting that Hailey take her insulin BEFORE meals and I did not want to do it that way. They win this one, her numbers are better BUT meals have become a battle at our house :( Hailey is 10 and understands but that I don't have a choice right now, that doesn't mean she has to like it.....

[jeep_bluetj]

We are doing Humalog and Lantus and already carb counting. You made the exact point that I was trying to make to the endo

And, imnsho, your point is exactly on track. If you're basal/bolus already, it really is just a different delivery method. You should switch to pumping.


Today I am emailing her numbers since they are insisting that Hailey take her insulin BEFORE meals and I did not want to do it that way. They win this one, her numbers are better BUT meals have become a battle at our house :( Hailey is 10 and understands but that I don't have a choice right now, that doesn't mean she has to like it.....

And those battles yeild perfect long-term responses in rebellious teens, right? At least with a pump you could easily go half before, half after, and remove that battle. Battles are BAD. We all (as parents) will have many, but dinnertime shouldn't be one of them.

Oh, and sorry too for the semi-hijack. The study concluded CSII from diagnosis is a good thing. And that's what I'm arguing too.

[Ellen]

May every hijack be so positive and productive :-)

Rev Endocr Metab Disord. (javascript:AL_get(this, 'jour', 'Rev Endocr Metab Disord.');) 2006 Dec 12; [Epub ahead of print]http://www.ncbi.nlm.nih.gov/entrez/query/egifs/http:--production.springer.de-OnlineResources-Logos-springerlink.gif (http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?itool=AbstractPlus-def&PrId=3055&uid=17160722&db=pubmed&url=http://dx.doi.org/10.1007/s11154-006-9018-9) Links (javascript:PopUpMenu2_Set(Menu17160722);)
The renaissance of insulin pump treatment in childhood type 1 diabetes.


Tamborlane WV (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_AbstractPlus&term=%22Tamborlane+WV%22%5BAuthor%5D),
Swan K (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_AbstractPlus&term=%22Swan+K%22%5BAuthor%5D),
Sikes KA (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_AbstractPlus&term=%22Sikes+KA%22%5BAuthor%5D),
Steffen AT (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_AbstractPlus&term=%22Steffen+AT%22%5BAuthor%5D),
Weinzimer SA (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_AbstractPlus&term=%22Weinzimer+SA%22%5BAuthor%5D).General Clinical Research Center, Yale University School of Medicine, New Haven, CT, USA.
Current goals for the treatment of children and adolescents with type 1 diabetes mellitus include achieving near-normal blood sugar levels, minimizing the risk of hypoglycemia, optimizing quality of life, and preventing or delaying long-term microvascular and macrovascular complications. Continuous subcutaneous insulin infusion (CSII), or insulin pump therapy, provides a treatment option that can assist in the attainment of all of these goals in all ages of children. In pediatric patients, CSII has been demonstrated to reduce both glycosylated hemoglobin levels and frequency of severe hypoglycemia, without sacrifices in safety, quality of life, or weight gain, particularly in conjunction with the use of new insulin analogs and improvements in pump technology. Clinical studies of safety and efficacy of CSII in children are reviewed, as well as criteria for patient selection and practical considerations using pump therapy in youth with T1DM.
PMID: 17160722 [PubMed - as supplied by publisher]

[Twinklet]

Mam2H, our Endo told us that research demonstrates pumping during the honeymoon period actually prolongs the honeymoon and is better for the body. If BG's are unstable during the honeymoon period, insulin doses are way easier to manage with a pump, as the basal can be different each hour. I guess I don't understand the rationale for waiting until the honeymoon is over, or waiting until date of diagnosis reaches a year. I can see waiting until all education and classes are completed, but a year? That doesn't seem rational, to me.