So, is pumping right for your child? To know the answer, you have to consider the good, the not-so-good, and the challenging aspects of pumping.

The Great Things about Pumps

The best thing about pumping, most families will tell you, is the freedom. For any child tied to a meal plan and shot schedule, the idea of complete freedom when it comes to scheduling life is a dream come true. Children are often freer to take part in other activities, too. Although a friend's parent probably would not want to give your child a shot, pushing a button on a pump would be something she could handle. Picture yourself sending little Bobby over to a friend's house for lunch. If he were on shots, you might have to send along a pre-drawn needle for the other parent to help administer. With the pump, you can simply tell the parent what number to push on the pump, or better yet, call Bobby and talk him through it as the other parent supervises. Many parents find the pump helps ease their worries when it comes to playtime.

Another pro to pumping, for parents, is the ability to tweak insulin doses and carbohydrate ratios to a degree that simply can't be done with shots. With a pump, you can adjust doses up and down by .05 units. Imagine trying to draw up to that tiny amount on a syringe. It's nearly impossible. With basal adjustments, you can change your child's insulin input every half hour if necessary. Best yet, when your child runs high, you can bring her down at the push of a button rather than having to worry about what other insulin type might be peaking in upcoming hours. Done well, pumping almost always means a decrease in A1c results, and it often means getting that lower number while allowing a child more freedom.

Pumps can mean fewer lows (hypoglycemia), too. One of the big concerns that pediatric endocrinologists had in the early years was that pumps would cause lows; however, it has been documented that kids on pumps tend to have fewer lows than kids on shots.

The Things That Make You Worry

Pumps are not all parties and freedom. Pumping means your child is only on fast-acting insulin. In other words, should the pump fail, the site clog, or something else go wrong, your child has no “safety net” insulin to fall back on in the absence of the short-acting insulin. This can be frightening to some parents, but the reality is, if you check your child's blood sugars regularly (at least every four hours during the day, and at night from time to time), you're not going to let your child go too far into a dangerous high blood sugar situation.

In addition, a child could develop ketones faster than she did on shots. The long-acting insulin is not there to back things up, so ketones can come on quickly.

That means that kids on pumps absolutely have to check their blood sugars regularly. If you're a parent who is fine with, say, three blood checks a day and don't want to add more, the pump is not the right choice for you and your child.

Another worry can be the notion of change. Often, children who have had diabetes for years are hesitant to make a treatment change and would rather stick to their tried-and-true shots. While it's a good idea to encourage children to try change, you cannot force a child to do so.

Parents might also worry about the pump if their child is active in sports. The good news is that while some sports, such as football, might require a child to unhook during play, there is no sport that rules out using a pump, since you can detach it for as much as an entire day if done properly (how to do so is discussed later in the chapter). For some kids and parents, however, the stress of disconnecting is too much, and they opt not to pump.

Lipohypertrophy

Lipohypertrophy is the bulging of an area of the skin due to the scar tissue and fat accumulation that forms when a person injects himself or inserts a pump site in the same spot over and over again. Kids can tend toward this habit for a number of reasons. Perhaps they don't like to try new spots, and a spot used over and over can lose its feeling (don't let anyone fool you; diabetes can hurt).

The danger is that insulin has a harder time being absorbed in these damaged areas. Your child must rotate spots, and you as parent must watch him and make sure he does. Ideally, insulin should go into fresh sites as often as possible. This alone might contribute to a decrease in your child's A1c.

Don't Fret at Saying No to Pumping

The community advocating pumps for children is a vocal and passionate one. As more and more children pump, you'll hear more and more about it for your child. If you do decide it's not for you, don't let anyone tell you the decision is wrong. As always, the person who knows what is best for your child and your family is you. Trust your gut and go with it.