Premium
Current Status of Pump Therapy in Childhood
Author(s) -
Becker Dorothy,
Kerensky Kirk,
Transue David,
Gutai James,
Nathan Susan,
Wolfson David,
Drash Allan
Publication year - 1984
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1111/j.1442-200x.1984.tb01834.x
Subject(s) - medicine , hormone , glycemic , insulin , gastroenterology , endocrinology
Subcutaneous insulin infusion (SCII) has been shown in adults, but not yet in childhood IDDM, to successfully induce long‐term improvement of glycemic control & substrate & counterregulatory hormonal abnormalities. We studied 17 adolescents aged 15‐ 19 yrs during conventional therapy (A), after 6 wks of intensive monitoring with1–2 insulin injections (B), after1–2 wks (C),1–2 (D),4–5, (E), &6–8 (F) mos, &1–2 yrs of SCII. One girl was unable to tolerate the pump for more than 1 wk. Three boys discontinued SCII after 2 & 3 mos because of interference with sports & inability to adapt, & two girls because of excessive weight gain & return to poor control. A poorly compliant boy died in his sleep after 10 mos of SCII. Four others continued SCII for at least 1 yr, at which time two changed to multiple dose injection regimens. The major decrease in whole blood glycosylated hemoglobin (GHb) occurred from A (12.3 ± 1.7%, SD)to B (10.8 ± O.8%, P<01). A further, decrease at C (10.1 ± 1.2%) was less significant (P<0.05). Thereafter, there was a gradual increase to 11.2 ± 1.2% (P=0.02) at D, 11.9 ± 1.6% at E, 11.9 ± 1.7% at F, & 11.5 ± 0.9% at G. The stable GHb followed a similar pattern with a significant decrease from A to B of 11.8 ± 1.6% to 10.2 ± 0.7% (P<0.05), a non‐significant decrease at C to 9.5 ± 0.9% at G. The stable GHb followed a similar pattern with a significant decrease from A to B of 11.8± 1.6% to 10.2 ± 0.7% (P<0.05), a non‐significant decrease at C to 9.5 ± 1.1% & 9.6% 1.0% at D. At E, F, & G, this rose to 11.9%, 10.3% & 10.7%, respectively, & the means were not different from our clinic population. Mean blood sugars during 24 hr sampling showed similar patterns. 24 hr measurement of glucagon, growth hormone, cortisol, FFA, & ketones significantly decreased during C. & D. These were occasionally below age‐matched normals. During SCII, there was increased incidence of ketoacidosis & some initial problems with infection. Many patients were unable to comply with the rigorous monitoring demands to make SCII safe & effective. Our data do not support the widespread use of SCII in adolescents, unless they unusual maturity & motivation.