Insulin Pump - a beacon of hope for children with Type 1 Diabetes
Type 1 diabetes is one of the most common endocrine and metabolic conditions in childhood and the number of children developing type 1 diabetes is increasing rapidly. According to International Diabetes Federation (IDF) Atlas, more than 1.1 million children and adolescents under 20 years are estimated to have type 1 diabetes worldwide.
In type 1 diabetes, the body cannot maintain blood sugar as the pancreas do not produce insulin, so patients have to take insulin for survival. Hence, insulin must be started when type 1 diabetes is diagnosed without any delay. Children and adolescents usually require multiple insulin injections (up to 6 – 10 times) with frequent blood tests to control their blood sugar levels throughout the day.
Moreover, appropriate eating behavior and healthy lifestyle with physical activity are advised. These all become cumbersome for most of the children and adolescents with type 1 diabetes. Several studies suggest that near normal glucose control prevents or delays complications of diabetes in children with type 1 diabetes. Despite the intensive management with insulin in multiple doses with monitoring of blood glucose several times at home, maintaining a normal blood glucose is always a challenge in type 1 diabetes.
As our daily lives have vastly changed with integration of new technologies including computers, smartphones etc., the management of diabetes is in the midst of a technological revolution. An insulin pump is an alternative device that delivers regulated and accurate amounts of insulin continually under the skin through a flexible plastic tube. Many children with type 1 diabetes are having needle phobia, insulin pump is a ray of hope for them. The plastic canula can be changed at a few days' intervals, so multiple daily pricks of injections will no longer be necessary.
Furthermore, It delivers insulin similar to the one our body produces and can be programmed to deliver multiple boluses in corrected amount which gives flexibility of life style in children and also reduces the incidence of hypoglycaemia (low blood glucose). The recent updated pump has sensors where CGM (Continuous glucose monitoring) can be done, so pricking for monitoring blood glucose would not be required.
Children with insulin pump had better glycaemic control as well as improved quality of lives compared to those under the multiple-injection treatment plan.[3] Most importantly it might improve patient's adherence to treatment and flexibility of lifestyle in a child. Furthermore, insulin pump has shown the lower risk of long-term complications found in few studies.
The use of insulin pump therapy has increased dramatically among the children and adolescents with type 1 diabetes (T1D) throughout the past decade. Insulin pumps have been used for many years in adults and children with type 1 diabetes worldwide, in Bangladesh, the practice is still relatively low. Lack of awareness could be one of the main reasons behind this.
According to the statistics of T1 Center in BIRDEM, the number of children with type 1 diabetes is increasing in Bangladesh every year. T1 Center in BIRDEM is the only multidisciplinary approach for Children with type 1 diabetes in Bangladesh. Insulin pump has been introduced in this center for last 2 years. Some with type 1 diabetes are having insulin pump and showed better glucose control with less complications. Type 1 diabetes is a lifelong disease and imparts significant effects to the patients, their family and society. A newer technology like insulin pump with CGM can help to achieve good glucose control with less complications and improve quality of lives in these children with diabetes.
The writer is a Consultant Paediatric Endocrinologist at the Department of Paediatrics and CDIC Paediatric Diabetes Center, BIRDEM 2, Diabetic Association of Bangladesh.