It’s hard to talk about managing your child’s diabetes without also talking about the high-tech devices available to help. Continuous glucose monitors (CGMs), insulin pumps, and hybrid closed loop systems are becoming available to more and more families and come with the potential to make your lives easier and less stressful. It’s no wonder you might want to get them as soon as you can! So you may be wondering: Is it possible — or advisable — to start on a pump or CGM right from diagnosis? Is there an ideal time to make the switch from finger sticks and multiple daily injections? What other factors, like family circumstances or individual personalities, should you consider when deciding whether the time is right, and which device to start with? Here are some answers.
First, as helpful as these devices are, day 1 in the hospital may not be the perfect time to start on them. That’s because even though the technology has come a long way, it still isn’t perfect. And that means pumps and CGMs can, and will, fail from time to time. When that happens, you need to know how to do things the old-fashioned way. “If you aren’t already familiar with type 1 diabetes, you may want to wait a little bit to first understand the fundamental principles of finger sticks and multiple daily injections,” says Benjamin Nwosu, M.D., professor of pediatrics at University of Massachusetts Medical School. “You don’t want to get a CGM and then not know how to check blood sugar with finger sticks if it malfunctions. By doing it manually first, you’ll have the skills to manage diabetes without the devices.”
It’s also easy to get overwhelmed learning everything at once. “Type 1 diabetes is a life-altering diagnosis, and at the beginning you’re trying to figure out how to do everything,” says Brynn Marks, M.D., pediatric endocrinologist with Children’s National Hospital in Washington, D.C. “The technology is another thing you have to learn on top of the basics.” That said, it doesn’t take long before you start to get the hang of things. “Most people feel comfortable doing finger sticks and injections within a week or two of diagnosis,” says Marks.
There are other factors to consider when thinking about when (and if) to transition to a diabetes device. Cost and insurance eligibility mean that unfortunately the latest devices are still not a viable option for every family. If they are available to you, also consider: Does your child want one? “We see evidence that if kids are forced into using these technologies, it isn’t good in the long term,” says Marks. “They want a say in this.” Also think about your child’s personality. “If you have a child who is hypersensitive, the beeping and buzzing that happens when they get a high or low can become a problem,” says Anna Simos, program manager of diabetes education and prevention for Stanford Health Care. “They can get hyper-focused on their diabetes and become afraid every time they hear the alarm.” That doesn’t mean you should skip the CGM completely, you just want to make sure your child is ready first.
Once you decide to make the switch, you have to decide if you go with both a CGM and pump at the same time, start with one or the other, or jump straight to a hybrid closed loop system. (This is a system that connects a CGM and a pump to automatically deliver insulin based on CGM readings.) There’s no one-size-fits-all approach, but many parents usually start with a single device. “If it’s too much to put two devices on a kid at once, and a lot of times it is, use a stepped approach,” says Simos. Her advice: Start with the CGM and add in the insulin pump later if you decide to use a second device. “The CGM takes a lot of the guesswork out and helps decrease anxiety for the parent,” says Simos. “They tend to give their child a little more freedom because they can see the numbers on their phone, so they aren’t as worried.”
For Nancy Johnson Horn, starting with a CGM soon after her son was diagnosed with type 1 was a no-brainer. “Everything I researched and every mom I talked to said to get one right away, and I figured, what was one more thing to learn at the beginning,” she says. “He runs track, and I can watch him remotely or catch a plummet during school and text his teacher.” They added in the pump four months later. “Our doctor didn’t want us to do both at the same time; he wanted to make sure we knew what we were doing before starting on the pump,” Horn says. “It was harder to learn, but it helps him lead an active life.”
If you think you ultimately want to go with a closed loop system and it’s available to you, talk to your doctor about starting with that instead of first going the CGM or pump route. “You might as well learn how to interpret the data and adjust the insulin doses in the closed loop system instead of learning the other devices and then switching,” says Marks.
This information should help you consider the right timing for starting on a device, but, as always, the best person to help you decide is your child’s healthcare provider. Bring up your interest and talk about your specific situation to see if it makes sense for you and your family.
Disclaimer: The experiences and suggestions recounted in these articles are not intended as medical advice, and they are not necessarily the “typical” experiences of families with a child who has type 1 diabetes. These situations are unique to the families depicted. Families should check with their healthcare professionals regarding the treatment of type 1 diabetes and the frequency of blood glucose monitoring.