“Pump School” for children with diabetes in Cork

A new service to help children with type 1 diabetes, and their parents and carers, better manage their condition has commenced in Cork.

Children with type 1 diabetes who normally receive insulin injections, up to five times daily, may be suitable for a new ‘insulin pump’ treatment and attend a dedicated ‘pump school’ to learn how to use the device. An insulin pump is a mini computerised device, which continually infuses insulin under the skin and optimises the blood glucose control.

This new service, which is being rolled out under the HSE’s National Diabetes Clinical Programme, is being made available to children with type 1 diabetes in Cork and Kerry who are clinically suitable. Children under five years of age are being prioritised.

The children, their parents, teachers and special needs assistants and other carers are trained to use and manage the insulin pump at an education programme delivered by a consultant led team from Cork University Hospital (CUH) at a dedicated pump school. This is the first dedicated pump school for children with type 1 diabetes in Ireland and the first time insulin pump therapy can be offered outside Dublin.

The pump school takes a day and a half to complete. The pump, which is small device about the size of a small mobile phone, is attached to the child via a plastic tubing just under the skin. The pump delivers a continuous amount of insulin, 24 hours a day, based on the requirements of the child and the amount of insulin delivered can be changed by the user (or their parent).

The child initially wears the pump for a week using only salt water, in order to get accustomed to using it and to identify any issues before starting on the insulin. There is intensive support provided by the health professionals during the first week to the families and by the third week they are usually well established in using the insulin pump.

Diabetes is a serious metabolic condition in which the body fails to produce enough insulin to regulate blood glucose (sugar). There are two types of diabetes (type 1 and 2) and if the condition is not well controlled, it can cause serious health complications. The vast majority of diabetes in childhood is type 1 diabetes, which is very inconvenient and generates a significant family burden for children and their carers, on a daily basis. The incidence of type 1 diabetes in children is increasing yearly and the incidence is at epidemic proportions in the under five age group.

The provision of insulin pump therapy to children under five years of age is part of the HSE’s National Diabetes Clinical Programme. Dr. Stephen O’Riordan, Consultant Paediatric Endocrinologist at CUH has been appointed the national lead for this programme. A second Consultant Paediatric Endocrinologist, Dr Susan O’Connell was appointed in CUH during 2012. These two consultant appointments have allowed for the commencement and maintenance of the pump school service in Cork. The team is comprised of two consultants who are supported by medical staff, diabetes nurse specialists and a dietician specialising in type 1 diabetes. In modern day diabetes care, these specialised staff are the core of the diabetes team who assist each family who commence on insulin pump therapy.

Dr. Stephen O’Riordan, Consultant Paediatric Endocrinologist, Cork University Hospital (CUH) and national clinical lead for the insulin pump programme in the under fives said, “Insulin pump therapy has evolved considerably in recent years and is now considered the gold standard for children with type 1 diabetes. Pump therapy improves blood glucose control and quality of life and reduces the long-term complications associated with diabetes such as: blindness, coronary heart disease and kidney failure. There is a significant practical benefit of pumps over injections for children and their families, for example, a reduction from five insulin injections per day to one infusion set change every two to three days. The reduced incidence of noctural hypoglycaemia (low blood sugar at night) is also of considerable benefit to children and reduces parental anxiety once established on pump therapy. Pump therapy is not for all and careful patient selection is at the core of successful insulin pump service.”

Evelyn McCarthy (6) from Millstreet in Co. Cork switched from having daily injections to the insulin pump ten months ago and her mum Christine McCarthy who is a GP is full of praise for the device. According to Dr McCarthy, “Evelyn is a new child since commencing the pump, she hated the injections and her dad Gerard and I had to cajole her daily around the kitchen table to take them. With the pump she can input her own data and more or less manage it herself. She has better control and it is less regimented as she can eat when she wants which she could not do when she was on the injections as we were trying to match her food intake and her insulin. And the added bonus is – the pump is purple!

“Attending pump school was invaluable and we got great back-up support from the specialist diabetes staff at Cork University Hospital when Evelyn first started on the pump. It took us about six months to get used to it and we haven’t looked back since. Evelyn has been able to go to swimming classes from school. Her teacher detached the pump before each lesson and re-attached it afterwards. Had Evelyn still been on the injections we would possibly have had to accompany her to the classes.”

The pump school service is provided by the CUH team in Blackrock Hall Primary Care Centre in Mahon and this link with community services allows for a more flexible and child/family friendly approach in a non-hospital environment. There are more than 400 insulin dependent diabetic children attending CUH, which is developing as a regional centre for many aspects of children’s health services and is the regional centre for paediatric and adolescent diabetes and endocrinology. To date, 20 children have already commenced on pump therapy in Cork and it is envisaged that a further 20 will commence therapy during 2013.

Gabrielle O’Keeffe, A/Operations Manager, HSE Community Services in Cork said, “In the past, children from this area had to travel to Dublin hospitals to access insulin pump therapy. These children are now returning for care here locally which is hugely beneficial. The service is at an early stage of development but it is a significant advance for our services in Cork”.

Kieran O’Leary, CEO of the Diabetes Federation of Ireland (DFI) said, “Research has shown that insulin pump therapy is one of the most effective ways to manage type 1 diabetes. Until now, local families of children with diabetes who wanted access to insulin pump therapy had to make the conscious effort to switch their diabetes care to a Dublin hospital. So we very much welcome availability of this new service in Cork which I am sure will open the door for many other children to access this therapy”.