The insulin pump is a significant step in proper diabetes management in the way to simulate the human pancreas. Insulin pumps undergo significant daily improvement every day to enhance their performance. The insulin pump is beneficial for children with type I diabetes mellitus. However, proper training and education of the children and their families are mandatory for the appropriate function of the insulin pumps. They should know how to use it properly and overcome the difficulties they may encounter and the different scenarios they may meet. The way still long to achieve our goals.

The insulin pump is a giant breakthrough in diabetes mellitus (DM) treatment. Treating diabetes with an insulin pump is the method most similar to the normal physiologic function of the pancreas. The pump delivers insulin in 2 different ways simulating the human pancreas. It delivers a continuous small insulin quantity as a “background insulin” to maintain the basal metabolic rate and bolus insulin doses when needed to metabolize the ingested food. The insulin pump is particularly needed in the management of type I DM. The insulin pump is continuously undergoing massive improvement.

For a long time, there is a need for proper management of children with diabetes. The result of many aiticles review showed that despite the many challenges that enface the use of insulin pumps in children, the advantages are far more than the challenges.

INDICATIONS OF INSULIN PUMP

The Key target of diabetes management is to maintain adequate and optimal glycemic control to reduce the risk of metabolic derangements in different tissues. Although it may be a simple goal, it is not always easy to achieve in practice. There are currently two ways to deliver insulin: Multiple daily subcutaneous injections (conventional insulin therapy) or continuous subcutaneous insulin infusion, also identified as insulin pump therapy.There are many difficulties with conventional insulin therapy, including the variable glycemic control with frequent occurrence of hypoglycemia, abnormal weight gain related to the insulin therapy, augmented by improper dosage calculation related to human error, and the lack of adherence to insulin therapy, especially with multidose regimens. Using an insulin pump to manage DM depends on many factors, including the patient’s desire, daily life routine, and knowledge and experience with the disease. More than 25% of patients with type I DM are currently using insulin pump therapy. It is especially indicated in the presence of high hemoglobin A1C, poor glycemic control with problematic hypoglycemia such as nocturnal hypoglycemia, recurrent hypoglycemia, activity-induced hypoglycemia, recurrent diabetic ketoacidosis, frequent hospitalization, large total daily dose, presence of progressive complications such as gastroparesis, inability to self-administer insulin (such as in pre-school or grade-school children), the need for more meal time flexibility, or the inability to predict food or meal intake (such as in infants or toddlers). Baretić et al showed that nocturnal hypoglycemia is the main indication for insulin pumps in adults with type I DM, especially with limited affordability. Patients with type 2 Diabetes who fail to have adequate glycemic control with multidose insulin therapy may have better control with pump therapy, improving HbA1c, and limiting weight gain. So, the insulin pump can be sued for type I and II DM in adults and children, especially for those who want more flexibility and proper mealtime adjustment. About 1/1000 of patients with DM are currently using insulin pumps, and their number is increasing; 90% have type I DM, while only 10% have type II. About 6% of adult patients with type I DM use it, while it reaches about 19% in children with type I DM.

 

TYPES OF INSULIN PUMPS

There are two main types of insulin pumps; the first type is a ‘tethered’ pump that uses a fine tube connecting the pump with a cannula .The patient can wear the pump in a pocket or fasten it to a belt and should change the tubing every 2-3 d. The patch pump (micro pump) is another type without tubing or may have a very short flexible plastic tube (cannula) inserted under the skin .The pump usually adheres to the skin with an adhesive patch and is wirelessly controlled with a handheld controller unit.The insulin pump is generally formed of the central pump unit connected to an insulin reservoir which usually holds between 176-300 units of short-acting insulin. Another new version of the insulin pump has a built-in Continuous Glucose Monitor (CGM). The pump is supplied with an alarm system activated when the blood glucose reaches a predetermined low or high level.A SmartGuard Technology can be added to CGM to stop insulin supply for two hours if the user’s blood glucose reaches a predetermined low level pre-settled without activating the alarm system. Some pumps use a hybrid closed-loop technology by using the SmartGuard technology to permit the users to select from increasing the levels of automation that best suit their needs. The auto mode enables automatic adjustment of the basal insulin delivery according to the glucose reading of the user’s CGM sensor and recent insulin delivery.

There is also a bolus calculator, able to automatically calculate the doses and inform the person if they are too closely set together. However, in this mode, the user should enter the details of carbohydrate intake, confirm the mealtimes, and adjust the correction boluses. Some insulin pumps have an Insulin on board (IOB) feature so that the pump can calculate how much insulin remains active in the patient’s body from the previous insulin bolus dose. Some pumps are also waterproof to tolerate up to 12 feet underwater for about 24 h. This feature enables patients with diabetes to enjoy swimming with minimal risk of hypoglycemia. The vast advances in insulin pumps are related to significant software and artificial intelligence progress. For example, some pumps allow choosing an exercise set to change the person’s glucose target automatically. Most of the new versions of insulin pumps are compatible via Bluetooth with smartphones with different applications which allows family members or caregivers to access the patient’s information and show all readings and permits notifications and alarms. People also can deliver insulin remotely using a smartphone-like Personal Diabetes Manager device. The suitable age for the pump use differs according to the pump type and version, in which the manufacturers determine the appropriate age of use according to each pump’s features.