When Zachary Ullman was 15-months-old, his parents got the shock of their lives. The symptoms he'd been exhibiting-thirst, weight loss, excessive urination-were more than the usual childhood problems. Their baby had diabetes.

Ellen recently described the frustration and fear she and her husband experienced when injecting the child with insulin. The Boca Raton, Fla. residents worried about Zachary's health even more than average new parents.

As the boy grew, his parents injected his insulin. Ellen says, "It was horrible at first, but he later developed a good attitude. "

However, there were concerns-no matter how diligently Zachary and his family worked to maintain normal blood glucose levels, his control was never very good and he was drained of energy. The regimen of snacking, injecting, and testing is a trial for even the most responsible person. For a young boy, the limitations can be especially trying.

"We never knew exactly when the NPH would peak," Ellen explains. Though she is active in diabetes support groups which help her stay on top of the latest developments, she says, "I had never really considered the pump."

Diabetes Research Institute had an introduction to the pump in January 1995, but Ellen didn't think it was an option for Zachary because he was so young. Several months later, however, she met a mom at a support group whose seven-year-old was on the pump.

And the rest, as they say, is history.

In June 1995, at the age of seven, Zachary made the decision to go on the pump. His physician, Robin Nemery, a pediatric endocrinologist at Joe DiMaggio Childrens' Hospital in Hollywood, Fla. supported his decision. Nemery is one of very few doctors in the country willing to put children on the pump, and Bruce W. Bode, MD of Atlanta Diabetes Associates says she "may have one of the larger childrens' pump practices in the world."

Nemery explains, "Parents need to determine if their child really wants the pump. They must be willing to check their blood glucose at least four times a day, and bolus at lunch when they're at school. Some of my patients can't even tell time yet, but if they can play a video game, they can work the pump. If parents are willing to get involved, it works very well."

She warns that age is not a good determiner of when a child should be put on the pump. "My youngest patient [on the pump] is seven, but there are some 10-year-olds, or even teens, that I would not put on it. It depends on the child and the parents. Some children are not supervised enough, and some are coddled because of their diabetes."

Nemery explained to the Ullmans exactly what they would be getting into. According to Ellen, what they were getting into was a better way of life.

Like adults who attain better control, children begin to feel better once they go on the pump. Unfortunately, infants are not good candidates for the pump since they do not have enough subcutaneous tissue and their body size is not large enough to safely place the needle.

"Many kids should be given the option to go on the pump," she says. "The flexibility it's brought to our lives is incredible. It's so liberating!"

Even when a child is out of sight or at school, most parents can feel comfortable with the pump. By getting a copy of the school menu, parents can calculate their child's boluses in advance, and a watch with an alarm is helpful for reminding a child when to bolus. Nemery says she has never had a bad experience with one of her young pumpers.

"Zachary's blood glucose improved dramatically," Nemery says. "He used to have to be very preoccupied with food and the time, and now he doesn't have to be anymore."

Zachary is not the only one of Nemery's young patients to jump on the pump. Nine and a half-year-old Willy Boardman got his in July after seeing a child with one at a party. His mother Faith says, "It's an experience we wouldn't trade for anything. I would not trade it for multiple injections.

"Nothing is ever as hard as the first few months after your child is diagnosed," Faith says of Willy's diagnosis at age seven. "Another change is hard, but for the first time last week he had a cupcake with frosting at a birthday party. That's full participation, it's really neat for him. He didn't have to excuse himself and go get a sugar-free popsicle."

Like Zachary, Willy has no problem with activity. In his pre-pump days, when his control was less predictable, he was often tired and cranky. During this interview, Willy was building a treehouse in the backyard.

"Now he has no inhibitions," his mom says. "He can swim, ride his bike through puddles. We don't worry about the pump. He's freer and can be active for longer. Since pumps work faster than injections, Willy has a general better feeling, more energy.

"With NPH, it's hard to predict if a kid is active. Last year it took two months to adjust his insulin when school started, since he has to sit all day. This year it took two weeks."

She adds with pride, "Willy has always had a good attitude. He always says there are worse things than having diabetes. In fact, he thinks he's special by being on the pump."

There was fear that the other children would tease him for wearing the pump, but it turned out they were enthusiastic and curious about his "difference." The other childrens' interest in his blood glucose testing was enough to disrupt classtime, but Willy has managed to make it a part of everyone's routine.

Nemery says that there are no pumps on the market designed especially for children, a fact she would like to see change and which could happen if more doctors become willing to put kids on the pump. One problem with standard pumps is that the length of the tubing is designed for adults, too long for most kids. Also, since children tend to be more active than adults, the device may malfunction more often.

Why don't more doctors consider this option for kids? Dr. Nemery, who has placed approximately 45 kids on the pump without problems, thinks the reason is that doctors are unwilling to learn to use the device and teach their staffs about it.

"It's a big undertaking. People are afraid of the unknown. The pump has been available for 12 years, and there were some early technical problems which may still scare people. But you never know until you try. I've been putting kids on the pump two and a half years now, and so far so good."

The Diabetes Control and Complications Trial did not count children under 13 in its research, but Nemery says that kids are not immune to complications. Poorly controlled diabetes can stunt growth and delay puberty. She knows of a 16-year-old boy who developed retinopathy. Despite this, even some parents are hesitant to consider the pump. One reason may be the expense. No matter how much a person loves their child, if the money is not there, there are not a lot of options.

According to Dr. Bruce Bode, "There are currently two insulin pumps available in the United States. One is from MiniMed, a U.S. company, and another is from Disetronic, a Swiss company. The initial cost of an insulin pump is approximately $4000 to $5000 with ongoing supplies being $40-$60 per month. The pump companies warranty their pumps for up to four years with insurance covering usually 80% or more of the cost of supplies and the pump."

Nemery points out that insurance companies take too arbitrary of an approach to granting children coverage for the pump.

"If you're putting a child on the pump, you have to fight with the insurance companies, you have to become a patient advocate. I don't think people realize what's happening to our healthcare industry."

She notes an all-too typical incident with an 11-year-old patient, Jennifer. The girl takes good care of herself, administers four insulin injections every day, and monitors her blood glucose faithfully. Her parents' insurance, Blue Cross/Blue Shield PTC, refused Jennifer's request to go on the pump. The child must continue to inject her insulin.

Nemery says that insurance companies will save the cost of the pump many times over if they help children like Jennifer prevent complications. She believes managed care is losing sight of that fact. She adds, "Everyone should be offered the opportunity to experience the benefits that control can offer."

Faith Boardman concludes, "The better the control, the longer our children live. What price can you place on that? If it means a second job, that's what it means. I could not be happier-I've got my baby back."

If you would like to contact Ellen Ullman, she can be e-mailed at lavw30a@prodigy.com