Q: Our son is 11 years old, and has been on the pump for six months now. He told us that he is having problems with the pump because all the other kids ask him so many questions. He also says that he wants to go back to shots this summer so he can wear shorts and go swimming.
The only sights that he uses are his thighs. He is very thin, and has very little body fat for other sites to feel comfortable. What are some solutions to this problem?
Dawn and Kyle
Brooklyn, New York
A: If your son has recently gone on the pump, it is understandable that he is growing tired of questions from other kids. As pump therapy is new for him, it is also new for those around him. As the novelty of the pump wears off, it will also wear off for his friends. Because children are so heavily influenced by their peers, the best thing your son can do is to get to know children his own age that wear a pump. Many parents report that their child had no interest in pump therapy until they began talking with a pump wearer who was close in age. Your son’s physician may be able to introduce your family to other families with children of a similar age.
There are several different infusion sets available regardless as to which pump is worn. Hopefully, your son is using an infusion set that is inserted at an angle (Comfort, Silhouette, or Tender). By using this type of infusion set, as compared to one that is put straight down into the skin, the pump wearer is able to have more control over the angle and the depth to which the cannula is placed into the subcutaneous tissue or fat.
Has he tried placing the infusion set in his upper thigh or abdomen? Among the 84 teens and preteens that I have placed on a pump, the question, “Where’s the fat?” has often been asked. If put in properly, the right infusion set can be placed in almost any amount of fat. The lean bodies of wrestlers have been the most difficult. In a couple of instances, these boys have placed the infusion set in the upper and outer thigh. Curtis, a 16-year-old who has been on the pump for six months, has little body fat and will not consider placing the set in his abdomen. He recently told me he has been rotating his infusion sets from his outer thighs to his hips.
Even if it seems that all that can be pinched is the skin, your son may want to try his abdomen. The abdomen tends to take much less abuse than legs, hips or arms. The kids who do crunches during weight training have the most difficulty using the abdomen.
Many kids benefit from using products such as Emla Cream to numb the surface of the skin. This cream is placed on the surface of the skin 45 minutes to an hour prior to site insertion. Although this creates more work, it is often worth it to those who have a difficult time placing an infusion set in the abdomen. Emla Cream is a prescription item, so you may want to talk with your doctor about using it or another similar product.
The success of pump therapy is largely dependent on the pump wearer’s desire to be successful. If your son was eager to use an insulin pump, gently remind him of his reasons for wanting to try pump therapy and the positive thoughts he had before going on the pump. It sounds as though he may need reassurance and encouragement from you or even his physician. Has your son’s glucose control improved since he began pump therapy? If it has, this may be another item to point out to him.
If your son was not eager to try pump therapy, pushing him to remain on the pump will only cause more frustration for the entire family. An important aspect of successful diabetes management is a sense of overall well-being. Removing the pump for the summer might compromise your son’s control to some degree, but if he currently has a negative attitude about the pump, his good control will ultimately suffer anyway, and his sense of well-being will be poor.
Kim Boaz-Christy, RN, BSN, CDE