From Dr. William V. Tamborlane
Professor of Pediatrics
Yale School of Medicine
New Haven, Connecticut
USA
After more than 50 years of heated debate, the results of the
Diabetes Control and Complications Trial (DCCT)1
showed without a doubt that blood sugar control of diabetes matters.
If patients with Type 1 diabetes are able to achieve improved control,
they will be able to avoid many of the complications of diabetes
later on. The DCCT also showed that improved diabetes control is
just as important for adolescents as it is for adults with diabetes.
However, this puts an extra burden on young people and their families
because diabetes is most difficult to control during childhood and
adolescence.
The DCCT results have caused a dramatic change in our Children's
Diabetes Program at Yale. The staff (nurses, dietitians, social
workers and physicians) have doubled our efforts to achieve improved
diabetes control. Even more important, the kids themselves are much
more committed to getting control of their diabetes. They come for
visits more often, do more blood sugar testing, and take more injections.
They want to know what their glycosylated hemoglobin2
levels are and work to keep them as near normal as possible. They
know about the increased risks of hypoglycemia and do the best they
can to avoid it.
One of the most gratifying changes for me has been the re-birth of interest in the use of the insulin pumps by teenagers. As a pediatrician who helped develop pump treatment in the late 70's and early 80's, it was very disappointing that so few young people with diabetes were willing to try pump treatment. Many adults benefited from pump therapy, but not teenagers. Back then, it was easier to take one or two injections a day, check blood sugar levels infrequently and not care about the future. Most of the time, it was the parent and not the teen who inquired about using a pump. Now, as our teens are dedicating themselves to getting improved diabetes control, many are realizing that pump treatment has great advantages. Extra insulin can be given with every meal and snack without having to take a separate shot, and overnight control can be easier and safer by varying the basal rate of insulin. The latest models of the Medtronic MiniMed pump and infusion sets have new features that make the pump easier to use. Over the past two years, we've had more teenagers try a pump for the first time than ever before and the results have been spectacular.
Most of us get very comfortable with things that we know well and
are at least a little afraid of trying something new. You know what
it's like to take your insulin injections but not what it's like
to use a pump. The purpose of this manual 3
is to help you get over that hurdle. It will provide you and your
family with the rationale behind pump treatment and a much clearer
understanding about what the treatment involves. It is intended
to add to, not replace, the instruction that you will receive from
your diabetes treatment team and to serve as a reference for questions
that may arise in the future. We want you to get off to a good start
with your new pump and we expect that in a few months you will wonder
why it took you so long to decide to try one.
Dr William V. Tamborlane, M.D.
Professor of Pediatrics
Yale School of Medicine
New Haven, Connecticut
USA
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