Starting pump and CGM at same time in 3 year old


(thawkins) #1

Hi - does anyone have any experience with starting a young child on a pump and a continuous glucose monitor at the same time?

My daughter is 3, was diagnosed 2/18/09, and is having trouble with wild BS swings (her A1c was 9.1 too). At the same time, my wife and I are at our wits end with constant checking her for lows - we are up once or twice a night to check her BS, and even when she is awake during the day, she will have a lows and give no indication of being low. Last week she was running around perfectly happy and we happened to check her and she was at 44. It was pretty scary, especially since we had no indication otherwise. So we thought getting her on a CGM might be a good idea.

We are definitely committed to switching her from shots to a pump, as is our doctor, but when my wife and I inquired about also starting her on a CGM at the same time, everyone from the doctor to the diabetes educator has tried to talk us out of it (at the same time as the pump). They seem to think its too much technology to handle, too much for our daughter to handle all at once. We feel like we can handle it and its worth trying - I'm also T1 and we are at least somewhat knowledgeable about all this.

Anyway, has anyone else had experience with switching to both a pump and a CGM in a small time with a small child?


(joe) #2

IMO it's a mistake.  too much too fast. 

The pump requries a lot of testing.  A cgm does not free you from frequent testing.   CGM can be up to 30 minutes behind reality and may not catch a low that is coming on fast.  I have both, and I do not depend on my CGM reading to make insulin decisions.   I use it for overall trending and precision pump tuning.

A CGM requires calibration, incorrect claibration can make the CGM reading 50+ points (mg/dl) different from a finger stick test.  It will be years before a CGM can replace your meter.

The pump basal programming will take over a month, during that time you will be doing testing at about 10 finger sticks a day.  You will be skipping meals in order to test if blood sugar is rising or falling without a meal.  it is trial and error.  A growing child will need basal adjustments for every 10 lbs or so of weight gain.  Pump therapy can be a huge benefit, can reduce swinging, can eliminate the overnight issue, but it would be best if you concentrated on tuning it and not staring at a CGM number.  =)  I am a instrumentation expert for process engineerg controls, and I wouldn't start both at the same time - but again it's just my dumb opinion!

good luck.

 


(stanandkathie) #3

My daughters dr says the same thing.  He isn't so worried about me as much as he thinks it is too much for her.  She is 5 and he thinks that if we start hooking her up to a bunch of things that she will just freak out and not want to use any of it.  We are going to do the pump for a few months and when she gets used to it then we will start the cgm.  We are hoping to have both in place before school starts this fall but we are taking at my daughters pace so that she doesn't get overwhelmed.


(thawkins) #4

Thanks for the comments. We meet with the endo this week and are going to talk it over with her again.