"It wasn't just discovering that our son had diabetes that was so difficult, it was realizing that we had to give him multiple insulin shots and take his blood every few hours. And his reaction to this -- that turned life into a terrible nightmare for all of us," says Sheri Z., a New York attorney whose eldest son, Sammy, was diagnosed with Type I diabetes shortly after his third birthday.
In Type I diabetes, the cells of the pancreas -- where insulin is made -- slowly die out, so the body has virtually no way to clear sugar from the blood. Without daily doses of insulin, sugar loads can build to such a degree that death can result.Because of an allergy, Sammy required the use of short-acting insulin, which had to be administered every few hours via injection. This, combined with the need to continuously draw blood for testing, turned a peaceful home into a tearful battlefield.
"Every time he saw me coming with the needles, his little eyes welled up with tears and he would say, 'Why do you and Daddy hurt me all the time?' It would just about tear my heart out because how do you explain to a 3-year-old that jabbing him with a needle every few hours is saving his life?" Sheri says.
Until recently, the only way for Sammy and other little children to get their daily insulin supply was through the painful injections, at various intervals throughout the day and night.
However, that's starting to change, thanks to insulin pumps -- tiny, beeper-sized devices that painlessly infuse pre-programmed amounts of insulin directly into the body through a thin, removable catheter inserted just under the skin.
While widely acclaimed for use in adults and older children, few doctors believed the pump could work for pre-schoolers. Fortunately, Sammy's physician, pediatric endocrinologist Dr. Holly Schachner, was one who did believe. Now, less than one year after being diagnosed with the disease, Sammy is part of the small but growing number of children whose lives have been transformed by an insulin pump.
"He laughs and he plays -- he's like a normal kid now," Sheri says. "Peace has returned to our home, and it's wonderful."
While conventional wisdom holds that "very small children can't adjust to the pump, that they can't handle it, that they'll pull it off, this has shown not to be the case," Schachner says.
"In fact, if you take just a little bit of time to work with the child and help them adjust, they actually seem to do better with the pump than the older kids," adds Schachner, a physician at the Naomi Berrie Diabetes Center at Columbia Presbyterian Medical Center in New York City.
Medical studies are fast proving Schachner right. One such review by Dr. Michael Freemark and colleagues at Duke University found that with proper supervision, young children with Type I diabetes can safely and successfully turn to the pump as their sole source of insulin.
In the study, nine children between the ages of 20 months and 5 years old were treated with insulin pumps for between seven and nineteen months. Throughout the trial, parents were instructed to monitor the children's blood glucose levels at least four times daily.
The study result: Not only did the pumps prove effective in controlling insulin levels, parents were overwhelmingly happy with how well the pumps worked. This was evidenced by a drop in the parents' need to contact doctors, from once every six days before the pump, to once every 46 days by six months into the study.
"In conversations, parents stressed their increasing level of comfort with diabetes management, their sense of improvement in quality of life for all family members, and their high levels of satisfaction with pump therapy," Freemark said at the recent Pediatric Academic Societies' annual meeting in Seattle.
The pump is also a more medically sound way of controlling blood sugar levels in young children, says Freemark, chief of pediatric endocrinology and diabetes at Duke University School of Medicine.
Because insulin doses for children are so small, and because kids' levels of physical activity and eating patterns can be so erratic, continually administering the correct insulin levels can be difficult, says Freemark.
With the pump, which can be set to infuse even tiny amounts of insulin on a regular basis, the children in the study experienced much improved blood sugar levels. There was also a reduction in episodes of severe hypoglycemia, a condition in which an overload of insulin causes a rapid and dangerous drop in blood sugar and possibly a coma.
As promising as these results are, both Freemark and Schachner agree the pump isn't right for every young child -- or parent.
"It requires strong parental motivation and a good, basic understanding of the pump and how it works," says Schachner. "You have to continuously monitor the child, and their blood sugar levels. In short, it takes quite a bit of work on the parent's part."
For Sheri and her husband, nothing could be more motivating than seeing their child's health prosper.
"The change in Sammy has been astounding, worth every minute of time it took to get the pump working right for him," Sheri says.
What To Do
For more information on insulin pumps and how they work, visit the Naomi Berrie Diabetes Center. To learn more about Type I diabetes, visit Juvenile Diabetes Research Foundation International.