Saturday, March 6, 2010

Why do they do this?

This topic often comes up when speaking with parents of children with diabetes. The child becomes non-compliant (don't you just love that word?) and the endo threatens to take the child's insulin pump away from them.   I really do not understand the reasoning. 

If you child is not bolusing, testing, etc--basically not doing their daily diabetes care by pressing buttons, what makes the professionals think that drawing up a syringe will make them that much more accountable? I think I would feel better if my child had a pump because then I would know that the basal rate is at least being delivered.  If they are on shots they may miss injecting the basal dose the same as they are missing the bolus amount.

Maybe they think that if they are injecting that Mom or Dad will be watching the injection and make the child more accountable? What is the difference between  Mom or Dad watching/doing an injection versus them bolusing or supervising a bolus on a pump? I am honestly stumped by this. 

In defense of the endos however, I have heard of parents who felt that, in some cases, this can be the way to go.  It has been suggested that the psychological implication of being attached to something like an insulin pump 24/7 can become difficult for preteens or teens.  The constant reminder of their illness becomes too much for them. We know that they just want to be "normal" kids and not stand out in any way.  They are often too young to realize that normal is just a setting on the dryer.  They have yet to realize the importance of being an individual. 

Another reason for "taking away" the pump has been to restrict freedom.  In all honesty, I do not exactly understand this reasoning.  The idea is that without the pump the child will have to go back to routine meals and eating habits.  I find two problems with this.  First is that kids will be kids and if they are sneaking food or not bolusing, the lack of a pump and having to inject for food will not change this.  If they didn't bolus they will most likely not inject.  If they were sneaking and not telling what they ate, why would the lack of a pump make that behaviour change?  The second problem I have with this is that most people using injections will now be put on a long lasting insulin like Lantus or Levemir.  They do not require the strict eating schedules of NPH and regular insulin.  They allow a child to pick and choose eating times. Yes, they could be put on an NPH regimen but why would you do that when research shows the basal/bolus regimen to be better for your child? 

The biggest thing I have taken out of this debate is the fact that an endo should NOT be the one to say your child is not complying and should be taken off the pump.  It should be a decision made by the family in consultation with their diabetes team.  The child may in fact need a "pump holiday".  They may be overwhelmed and need a different method of delivery to help them cope. It should not however be a punishment with the pump being the reward.  Good health is the reward and it should be obtained in the best way for the person living with diabetes...and of course the sanity of the parents.  

No comments:

Post a Comment