Â鶹AV

Sugaring off party symbolically inaugurates centre for kids with Type 1 diabetes

The Montreal Children's Hospital of the Â鶹AV Health Centre opens Canada's first dedicated insulin pump centre. The mission of the new Pediatric Insulin Pump Centre is to treat children with Type 1 diabetes who use insulin pumps and to proactively prescribe pump therapy for all appropriate youngsters with diabetes.

The centre's multidisciplinary team includes endocrinologists and a nurse and dietician specializing in diabetes.

The MCH has been at the forefront of both the recommendations for use, and utilization of pediatric insulin pump therapy in Quebec, since starting their first patients in 2000. These patients now represent approximately 12% of their clientele, and the number is increasing.

"The growth in demand for insulin pump therapy was straining the hospital's limited resources, and our diabetes educators were spending increasing amounts of their time managing our 'pumpers,'" says Dr. Laurent Legault, head of the Diabetes Clinic at the Children's Pediatric Insulin Pump Centre. "Other centres are also soliciting our expertise, both as mentors for their health care professionals, and also as consultants for patients from outside of our own clinic. Providing services to this population in addition to our own was proving to be beyond the capacity of our team. We are therefore ready to open our freestanding Pediatic Insulin Centre, where these activities will be concentrated. In addition to providing clinical care, we plan to conduct research into aspects such as treatment satisfaction, measures of metabolic control and the impact on the quality of life of the pump user and his/her family. Currently, very little research of this nature has been conducted on the pediatric population."

Why celebrate the opening of the centre with tire d'érable?

We wish to celebrate the opening of the pump centre with a Quebec tradition that also celebrates the possibility of good diabetes control even when eating foods that challenge this control. We also wish to celebrate the improved quality of life of these children with diabetes, and their families, whose hard work to control diabetes has allowed their children to participate fully in the pleasures of childhood, by "thinking like a pancreas."

Many people still believe that sugar is forbidden when a person has diabetes. A child with diabetes who takes insulin injections must try to work treats and special occasions into an already organized pattern of meals and snacks. If the timing doesn't coordinate with their meal plan schedule, this may require an extra insulin injection — something that most children do not find pleasant — or accepting the possibility of high blood glucose later on. By testing blood glucose, estimating the carbohydrate content of treats such as tire d'érable, a child or teen using an insulin pump may calculate an appropriate dose of insulin, which can be given without an extra injection and which may result in well-controlled blood glucose levels.

Pediatric Insulin Pump Centre opens thanks to private donations

The launch of the Children's Pediatric Insulin Pump Centre has been made possible thanks to donations amounting to $250,000 from the J.W. McConnell Family Foundation, the Oringer Family Foundation, Medtronic of Canada, Novonordisk, Lifescan, Smiths Medical Canada Ltd, Disetronic Medical Systems Inc, and Bayer. These donations will allow the Centre to remain open for about 24 months. The Children's hopes the provincial government will provide sustainable funding to allow the Centre to continue operating.

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FACT SHEET — WHAT IS DIABETES?

There are three type of diabetes:

1. Type 1 diabetes
2. Type 2 diabetes
3. Gestational diabetes

An estimated two million Canadians have diabetes and about 10% have Type 1 diabetes (including some 30,000 adults). In Quebec, about 2,000 to 2,500 children have Type 1 diabetes.

Diabetes is a disease in which the body cannot properly store and use fuel for energy. The fuel the body needs is called glucose. Glucose comes from foods containing carbohydrates such as breads, cereals, pasta, rice, potatoes, fruits, milk, sweets and some vegetables. To use glucose for energy we need insulin, which is produced in the pancreas. Type 1 diabetes occurs when the pancreas no longer produces enough or any insulin. With little or no insulin, glucose builds up in your blood instead of being used for energy. This causes high blood glucose levels. When this happens, diabetics may:

• Feel tired
• Be thirsty
• Urinate often
• Be hungry
• Be moody

They may also:

• Lose weight
• Have blurry vision
• Get infections

Type 1 diabetes is an auto-immune disease and is not caused by eating too much sugar. Its causes are not completely understood.

Is diabetes serious?
Yes. Diabetes is the leading cause of adult blindness, kidney disease and heart disease. The risk of developing these complications increases with both the duration of diabetes, and with poor blood glucose control. Children, and especially very young children, are considered at high risk for developing these long-term complications because of the duration of time they will live with the disease and because the traditional methods for treatment (i.e., insulin injections) often do not provide optimum control for this population.

How is diabetes treated?
People with Type 1 diabetes must replace the insulin no longer produced by the pancreas with injections two or more times per day. This is not a cure, but merely a treatment. Additionally, they must test their blood glucose levels at least four times per day and follow a stable meal plan that matches their insulin dose with their blood glucose levels, food eaten and activity. Despite this, many people have fluctuating blood glucose levels that may fall too low, or rise too high.

The good news
If people with diabetes keep their blood glucose levels in a target range determined by their doctor, they can live a long and healthy life.

What is insulin pump therapy?
Insulin pump therapy is a form of intensive diabetes therapy that aims to improve blood sugar control. Pump therapy uses a battery-operated external pump, which is about the size of a pager. The pump continuously delivers fast-acting insulin under the skin through tubing called a catheter. The catheter is inserted using a small needle, which may be removed, leaving only the catheter or tubing under the skin. Every two to three days, the catheter is changed.

The preprogrammed pump automatically delivers insulin at a steady rate that varies throughout the day and night, based on individual insulin needs. A dose, or bolus, of insulin is given at meal or snack times based upon the amount of carbohydrate to be eaten (meal bolus) or when the blood glucose is elevated between meals (correction bolus). This is manually programmed into the pump by pushing specific pump buttons at the appropriate time.

Benefits of insulin pump therapy
Studies have shown that good glucose control is associated with a significant decrease in the risk of developing the long-term complications of diabetes; however, this improved control often results in increased risk of hypoglycemia, a short-term risk. There is very good evidence from adult and pediatric studies that insulin pump therapy can achieve better glucose control than conventional insulin injection regimens, and that this improved control is often achieved with less risk of low blood glucose. Low blood glucose has serious consequences for children with diabetes, such as seizures. If properly utilized, insulin pump therapy provides a treatment that comes as close to non-diabetic control as can be safely achieved.

Another important benefit of insulin pump therapy is the increased flexibility in lifestyle that the pump offers. This is important for all people, but can be particularly important for children and adolescents whose activity and eating schedules may vary significantly from day to day and season to season. Pump users can be spontaneous, with the user deciding on the spur of the moment what to do and when to do it. They no longer spend each day watching the clock, thinking about the next blood glucose injection or meal, and parents are less stressed by picky eaters or a sick child who refuses to eat.

WHY DON'T ALL PEOPLE WITH DIABETES USE INSULIN PUMPS?
The pump costs about $6,000 (it lasts about eight years), with supplies costing an additional $3,250 per year. Unfortunately, right now, Medicare does not cover the costs of insulin pumps.

Some private insurance will cover the costs of an insulin pump, but it is decided on a case-by-case basis.

In spite of the advantages, the insulin pump is not for everyone. Successful results are achieved with highly motivated people with a good understanding of diabetes, and who are comfortable with wearing a medical device 24 hours a day.