Choices, choices
Twenty years ago the options for insulin therapy was minimal. If you were insulin dependent you took multiple shots a day. You may have had a choice in the kind of insulin you injected, but that was about it. Today there are many choices: MDI (multi dose injections, either by syringe or pen), pump therapy, and nasal insulin (not widely used because of side effects, dose restrictions, etc).
For various reasons all 3 of my T1Ds pump. We have a health plan that *covers* the insulin pump, our lifestyle is conducive to this style of insulin therapy, and for the kids it means less pokes and a safety net that might otherwise not be there if we did MDI. Many people are surprised to hear that only 30-40% of patients with T1D utilize pump technology. You would think it would be much higher, right? Well, pumps are super expensive, and even if you have a great health plan the cost is prohibitive for many. Pumping is also less common the more remote the area you live; not all family doctors know how to program and properly use a pump. I’ve met many people who have used pumps, but prefer MDI; many people feel tethered to technology when on a pump, or prefer the effectiveness that a shot brings (there can be many delivery issues with pump sites, and tissue damage associated with prolonged delivery at one location).
If you do decide to pump, there are even more options to decide on: what kind of pump to use. We have always used Medtronic pumps, simply because that’s what Marshall first used nearly 15 years ago when he started pumping, it worked for him, and when the kids were faced with the decision we were already comfortable with the operating system. There are currently three companies that produce pumps, and within each company a few options of different models to choose from as well.
Like I said, Medtronic is what we use. It has a small pump that you wear on your hip, arm, in a fanny pack, stashed in your bra, you pick. That pump is then connected by a tube to a port you attach to your body, much like an IV. This site needs to be changed every 3 days or so. You still need to take a *shot* to connect this port, as the catheter stays under the skin. All pumps still require an initial shot to attach the port.
T-Slim is very similar to the Medtronic pump, with tubing and a pump that needs to be carried along on your body. There are differences in the pump technology, but otherwise the nitty gritty stuff is all the same.
OmniPod is the one pump that is different from the rest. With the OmniPod you wear a cartridge of insulin on your body, and the pump operating system is remote. You still need to change it every 3 days but there is no tubing. Many people like being “untethered”. Many adults like that it appears more discreet, since you don’t have tubes sticking out from your clothes, or that you can wear a dress and not have to worry about where you have to stick your pump. It’s also waterproof, and many people who do contact sports prefer this style of pump. Many parents like that the kids can be playing and doing their “kid thing” and not have to worry about snagging their tube and more specifically that they have control over the brains of the operation. Parents can keep tabs on the PDM which actually does the insulin delivery and they can make minute dosing adjustments for the kids and the kids have little worry over their diabetes care. This can be really great for the little ones, who you may want to shelter from the constant demands and stress of diabetes.
This is exactly why I have come to LOVE the tethered systems like the one we use. As the kids get older Marshall and I feel it’s crucial that they are a part of their diabetes care and decision making. Their insulin pump is their insulin pump, and they do the driving. Any time there is a bolus to be delivered, a blood sugar to be entered, or a calibration to be performed, they are the ones who do it. I know many parents who have decided to take over every aspect of their child’s T1D care. Their kids have little to no say in their bolusing, carb counting, or accountability. This in no way means the kids are worry-free, the kid still has diabetes after all! The parents, however, are trying to minimize this worry as much as possible. They will have their entire life to worry, and these parents are trying to shoulder the burden for as long as possible. While I agree, and with my whole heart wish my kids could be released of this burden, I also know that I’d rather they learn to care for themselves gradually over time, than be dumped with it all at 18 when they leave our nest.
Every year, or as we notice our kids growing and maturing, we introduce new responsibilities to them. The first year it was something small, like carrying their own glucagon and glucometer while at school and recess. Then it was adding up their carb loads at dinner, or checking their own blood sugars. By now, Ollie is checking his blood sugar and bolusing himself at school, as well as given the freedom to treat lows when he feels them. This is a responsibility he has earned by showing he understands what needs to be done for his health and safety. With each new responsibility there is typically a bit of hesitation on the kids’ part, as well as mine (because, let’s be honest!). They understand the severity of this task, and they don’t want to screw it up. But we reassure them that we wouldn’t have given it to them unless we were certain they were ready and able. And hopefully they also know that we’re always here if they need help.
This all feels like an experiment. No parent of a T1D kid has the answer. We’re all trying to do what we think is best for our kid. Is my way the right way for everyone? Hell no. I just hope we don’t mess them up too profoundly along the way.
