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Running Head: CHILDHOOD DIABETES

Childhood Diabetes:

Insulin Pumps Vs. Daily Insulin Injections

Aria Wellington

Youngstown State University

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CHILDHOOD DIABETES
Abstract

This paper discusses the relationship between Diabetes management methods for children with

Type 1 diabetes. Getting diagnosed with diabetes at a young age is a very overwhelming and

scary event as explained more in a person experience. Diabetes is a common and rapidly growing

health problem in many people in society. Diabetes is the result of nonexistent insulin or that

lack of insulin given off by the pancreas. There are many different ways to manage diabetes.

This text explores and seeks to answer the question of which of the two methods: an insulin

pump or daily insulin injections are more beneficial to young diabetics. Although many studies

report the method of an insulin pump to be the better option, many risks come with that method.

Most episodes of hyperglycemia, ketoacidosis, and lipohypertrophy occur with the use of an

insulin pump. Explained below in the context of the paper are the reasons why daily injection

sites are the better fit for young diabetics.

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Childhood Diabetes: Insulin Pumps Vs. Daily Insulin Injections

There is no specific explanation as to why people get diabetes. Some people will tell you

“it’s because they ate too many sweets” or “it’s because they were overweight, “ but that is not

true. Diabetes Mellitus is in short, a disease when the pancreas no longer can produce the insulin

that the body needs to break down the carbohydrates and sugar ingested throughout the day, with

no known cure. Testimony before the United States Senate (2006), produced the report “Juvenile

Diabetes: Examining the Personal Toll on Families, Financial Costs to the Federal Health Care

System, and Research Progress Toward a Cure” showing the effect this disease has on kids and

families, along with the disease being a way of life. Shaynah Jones, a witness before the

committee, stated “managing our diabetes takes a lot of time away from our family … we have

to stop what we are doing to check blood sugars or go somewhere to inject insulin. If there is a

high or low blood sugar…, then sometimes we have to cancel what we are doing so our parents

can take care of us” (p. 24). The onset of diabetes in children and in adults are very different.

Craig (1982) explained the difference “diabetes in childhood is rapid, the majority of diabetic

children reaching hospital within six weeks of the onset of the illness. On the other hand,

diabetes in the elderly may gradually bring itself to notice over a period of years” (p. 1). Since

the disease is different in various ages they are treated differently. Diabetes can be classified in

two ways those who need insulin, insulin-dependent, and those who can be treated with diet and

tablets, non-insulin-dependent. These are also known as Type 1 (insulin-dependent) and Type 2

(noninsulin-dependent). Most children who develop diabetes are Type 1, which uses insulin as a

treatment. Felman (2018) stated that “Insulin is a chemical messenger that allows cells to absorb

glucose, a sugar, from the blood” (“What is Insulin?” par. 1). Insulin doing this job provides
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energy to the body. When delivering this insulin there are two choices: insulin injections or an

insulin pump. The medication is administered into the tissue of the stomach, buttocks, back of

the arm, and lower back. There has been an abundant amount of controversy in which method of

administration is better. Many studies have reported benefits to the pump. Given in the magazine

article, Considering an Insulin Pump for a Young Child? by Bradley (2005) it stated benefits as,

“improved A1c” and “site insertion every few days instead of three or four daily injections” (p.

56). Slover et al. (2012) also argued that pump users would “benefit from improvements in size,

comfort, accuracy, and durability” (p.10). Along with Nuboer, Borsboom, Zoethout, Koot, and

Bruining, (2008) stating “quality of life… improved by pump treatment in comparison to regular

treatment with four daily insulin injections” (p.291). While these all sound like great benefits to

this method, there are more negative effects than positive. Although the insulin pump therapy is

a common tool that does not necessarily make it the best tool for young diabetics. Daily insulin

injections are more beneficial to children with Type 1 Diabetes, rather than insulin pumps, due to

pump complications/side-effects, medical problems that could occur, and my personal

experience with both methods.

Pump complications with injection sites and side effects are one of the biggest problems

with an insulin pump. Insulin pump sites are about the size of a quarter, they have a sticky side,

that attaches to the skin with a plastic needle that gets inserted inside the body, it also has a

connected tubing that goes from the site to the machine which the insulin gets transported

through. Pump sites should be changed every three days per company’s order. The sites can be

located in the arm, hip, thigh, stomach, and less frequently, the buttocks. This is to assure the

insulin is getting into the body correctly. Deeb et. al. (2019) assured that the reusing of needles

and failing to rotate injections correctly are recorded everywhere. Improper techniques can result
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in hypertrophic tissue, the increase of skin tissue, which can lead insulin to crystallize, along

with incorrect insulin dosages, and pain and leakage of insulin (p. 260). Even with the pump site

being changed within the three days many have encountered hyperglycemia, high blood sugars,

the last usage day of the pump infusion site. Ross, Milburn, Reith, Wiltshire, & Wheeler (2015)

explained the importance of rotating sites with the following:

This is in order to reduce adverse events including skin irritation, infection, swelling,

pain, itching, bruising, and irregularities in insulin delivery (due to occlusion of the

catheter, cannula dislodgement, insulin leakage, air pockets in the tubing, or tube

kinkage), which can lead to potential loss of glycemic control (p.1020).

However, even with following all the rules and changing the infusion site and changing batteries

every so often to avoid these events, they still happen, some in a very serious manner.

Recently Hanas and Ludvigsson (2006) learned there was a thirteen-year-old boy that

was using an insulin pump that was found dead in bed one morning because of an advertent

overdose of insulin. The download of the pumps log showed missed boluses throughout the day

resulting in a high glucose number that night. The boy gave himself high insulin doses leading to

his death (p.34). The insulin pump gives boluses, small amounts of insulin, automatically during

the day set prior by a doctor. Having missed boluses, as seen in this boy’s case, is simplified to

the body not getting any insulin throughout the day which can lead to major consequences. The

missed doses were most likely due to the pump having some kind of technological problem. Or

most pumps have an option to hold the buttons down and it will “lock” the pump. This is so

insulin is not being wasted when disconnected from the body during a shower or activity. This

option is a smart way to conserve insulin, but when leaning against a counter the buttons can be

pressed and without knowing the pump will stop giving those boluses. Users of the insulin pump
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can also accidently deliver doses of insulin unknowingly. Some incidents that happen are giving

insulin in the middle of the night, if the use of a remote or a case is involved the buttons can be

pressed accidently administering insulin. With daily insulin injections, these events can be

avoided. Insulin injections do not stay in the skin as an infusion site so the rotation of the

injection sites is moved more frequently, allowing the full dose of insulin getting into the body

without other complications. Without the buttons and technology that the pump possesses, there

is not any room with insulin injections to have unintended doses of insulin given or the chance of

not getting insulin that should be given routinely by the machine.

If given the chance, these small problems can result in larger ones, some needing

hospitalization and some possibly causing death. The illnesses that can occur are hyperglycemia,

high blood sugar levels, ketoacidosis (DKA), when the body produces excess blood acids called

ketones, ketosis, a mild form of DKA, and lipohypertrophy (LH), which is a lump under the skin

causing excess fat to build up. As stated by Deeb et. al. (2019) studies of insulin pump users

have shown dermatologic problems. Within these problems LH was among the most common

(p.260). LH can cause the insulin that should be soaking into the body to get trapped and lead to

Hyperglycemia. Studies claim to show the lowering of hyperglycemia with the use of an insulin

pump, however, there is no solid evidence to conclude this statement given by others.

Hyperglycemia can be determined by the symptoms that come along with it. Some symptoms

include increased thirst, headaches, frequent urination, and blurred vision. Hanas and Ludvigsson

(2006), both having careers in Pediatric medicine, reported the flexibility of the basal rate, a

constant insulin drip, to be the biggest advantage and also a major disadvantage. This is because

of it causing an increased risk of ketoacidosis because of the buildup of tissue (p. 34).

Ketoacidosis is one of the major reasons for hospitalization with diabetes. Ketoacidosis is the
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buildup of blood acids. Symptoms of this illness can be nausea or vomiting, fruity scented

breath, and pain aroused in the abdomen. To cure ketoacidosis and the dehydration that comes

along with it, most doctors will request a saline drip along with insulin to bring the glycose back

to normal and start leveling everything back out to where it belongs. These medical conditions

arise in insulin pump users more than in the alternative method of daily insulin injections. Daily

insulin injections help avoid these problems by simply being able to rotate the sites more often to

reduce the risk of lipohypertrophy, while automatically decreases the risk of hyperglycemia and

ultimately decreasing the risk of ketoacidosis.

In December of 2010, my life changed traumatically. I was admitted into the hospital for

low weight and hyperglycemia that was above 400. At this moment, my mother and I had no

clue what to think or how to act. This event was very overwhelming and very scary for both of

us. I can remember thinking what was going on and why everyone was being so crazy and

running around. I remained in the hospital for two to three weeks with the doctors to figure out

what was wrong. Finally, at the age of ten I was diagnosed with Juvenile Diabetes. No one in my

family had diabetes, so my mother and I had no clue what we were up against. My diabetes has

always been my priority and always has been under control, with this the doctor suggested that I

would be a great candidate for an insulin pump. At the time it sounded like a great tool. I would

not have to take daily shots, and I would not have to carry around as many supplies. So, three

years into my journey with diabetes, my mother and I decided that we would get an insulin pump

set up and see how it went. The first event we encountered was being a ten/eleven-year-old with

this machine attached to them gets a lot of looks and negative attention from peers and people

around them, resulting in hating the pump or self-esteem. Nuboer et al. (2008) recorded an

incident that an eleven-year-old girl refrained from the pump after three weeks because of its
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visibility when on vacation to the beach (p.293). Everything was great for the first year, and we

loved the pump. It was such an easy tool with small complications here and there. Sometimes I

would give myself a dose of insulin and find myself feeling the insulin running down my

stomach or my leg, I would find myself catching the tubing on the kitchen cabinets and ripping

the site out, or the tubing being kinked not allowing me the correct dose that I needed.

Eventually, these complications lead up to my ketoacidosis and hyperglycemia. The

bubbles, kinks in the tubing, and the insulin leaking out of the site was the start of my

complications happening. It effected the way the insulin absorbed into the skin and/or how much

insulin was getting in to the skin, causing the blood sugar to rise and create more medial

problems. With these complications I started experiencing hyperglycemia at home and tried to

get my diabetes back under control. Hyperglycemia leads to increased ketones which leads to

ketoacidosis most of the time. With my sugar being so out of control, I became severely sick. I

was not able to keep anything down and became a very grayish color. At this time, my mother

decided to take me to the emergency room. When we arrived, I had become so light headed and

nauseated that I could not stand and sank to the floor while my mom had me checked in. Akron

Children’s emergency room works to where the most severe cases that come into the ER get

called back first. Within five minutes, they called me to go back to be examined. Almost

immediately I was readmitted into the Pediatric Intensive Care Unit (PICU) at Akron Children’s

Hospital, with ketoacidosis. I was hospitalized with ketoacidosis twice in the span of having my

insulin pump, both for around four days each, before I decided to be removed from the pump.

Being on daily insulin injections has helped my health tremendously. I have since then controlled

my diabetes and blood glucose levels. When I decided to be removed from the insulin pump a

huge weight lifted off my shoulder. The pump is supposed to decrease the stress and
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complications of having this condition, but in my experience, it contributed a great deal to my

stress and sometimes my school work and emotions toward the day and people around me. Still

to this day I am on daily insulin injections and have not had another severe event concerning my

diabetes.

Diabetes is an incurable disease, but there are many treatments available to help correct

it. Depending on the diagnosis there is Type 1 and Type 2. Type 1 is insulin-dependent and

would practice insulin injections or an insulin pump. Type 2 can manage the disease much easier

with diet and tablets. Insulin pumps are a very common tool for diabetics, but not the best tool

for the job. Insulin pumps have many complications concerning site insertions. The pumps site

can form a bubble and the tubing can kink effecting the way and amount of insulin absorbs into

the body. These pumps also can cause health complications such as hyperglycemia, ketoacidosis,

and lipohypertrophy which can cause serious concern for normal health and diabetic

management. These conditions could all be prevented by the use of insulin injections because in

general the injections stop the buildup of tissue which leads to all the other complications. Most

cases of children that find themselves in these conditions end up hospitalized or in some cases

death. My personal experience through this process has made me realize; yes, a pump may be

more common or a simpler method, but it causes many risks for my health and my disease. The

health of a person is the most important thing to think about when living their life and having

diabetes just complicates it. Overall, diabetics need to realize the health issues that come along

with using or planning on using an insulin pump versus using daily insulin injections to manage

their diabetes.
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Reference

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