Injections and finger sticks are part of life for a child with type 1 diabetes. We've got suggestions to make the process easier.
How & When to Use an Insulin Pen
Uncomfortable little jabs are now part of your routine, if yours is one of the 15,000 American children diagnosed each year with type 1 diabetes (T1D). Our experts suggest simple ways to reduce the discomfort, and help your child adapt quickly to needles.
How insulin works
When a child has T1D, the immune system attacks and destroys cells in the pancreas called beta cells. Pancreatic beta cells produce insulin, the hormone we need to turn food into energy.
Without enough insulin, the amount of sugar (or glucose) in the blood rises to dangerous levels. This can cause long-term complications such as kidney failure, heart disease, lower-limb amputations, and blindness in adulthood. That's why kids with T1D have blood glucose levels checked throughout the day and night to help keep the sugar levels within target range. Using a lancet, you'll likely prick your child's fingertip for a drop of blood six or more times a day, and place it on a special test strip in a blood glucose meter. Based on that reading, you'll know how much insulin your child needs to keep blood sugar levels in range.
Shots and pumps: the basics
You can give your child insulin in a few ways, depending on what works best for both of you.
The oldest method is through multiple daily injections with a syringe or insulin pen, which is a disposable needle tip placed at the end of a marker-shaped device that contains a pre-filled insulin cartridge.
An alternative to injections is an insulin pump, a beeper-sized computerized device often worn on a belt or in a pocket. It delivers an ongoing low dose of insulin through a small tube inserted into your child's body through a needle. The tube is then taped into place and the needle removed. An insulin pod pump combines the tubing and insulin cartridge of a pump into one device that adheres directly to the body.
Whenever a child wearing a pump eats or has an elevated blood sugar level, he pushes a button on the pump to deliver an extra amount of insulin, called a bolus. (Parents or caregivers will need to do this for younger children.) The site of the pump's tube needs to be changed (usually by a parent) every two to three days to prevent infection, and also because it's harder to control glucose levels when insulin is always infused into the same area. Shots are a less expensive route and require less education and training than what's needed for proper use of the computerized insulin pump, according to the Harvard-affiliated Joslin Diabetes Center in Boston.
On the other hand, a pump offers more flexibility because it continuously delivers insulin and only requires one needle stick every two to three days when the site is changed. One downside to a pump is having something physically attached to the body, which some people don't like.
Both the injections and pump require education and understanding of how to avoid hypertrophy, which is when insulin doesn't absorb very well. Hypertrophy develops if insulin is constantly given in the same spot.
Making it easier
Whatever method you choose, injections can be painful and scary at first. But kids generally get used to them after a few weeks.
Until then, "distraction is one of our best friends," says Parents advisor Lori Laffel, M.D., M.P.H., chief of the pediatric, adolescent, and young adult sections at the Joslin Diabetes Center. Allow your child to hug a stuffed animal or watch a favorite TV show on a computer or tablet to help him mentally prepare.
Sarah Kimball, M.D., a pediatrician in New York City, grew up having T1D. Her son, 7-year-old Sam, was diagnosed when he was 5. Dr. Kimball has learned new comfort techniques since the days she needed them as a child:
- Create a calm environment. Fear and tension exacerbate pain, she says. Bracing or clenching for a needle makes it more painful; relaxing makes it less so. Use whatever seems to calm your kid; Dr. Kimball suggests letting your child watch a kid-friendly show on a smartphone or tablet.
- Keep one bottle of insulin at room temperature because cold insulin can hurt going into the skin. An opened vial of insulin can be stored at room temperature (up to 86 degrees) for up to 28 days, but it degrades quickly in heat, so be aware of the temperature. You'll generally have a few months' worth on hand, so store the unopened bottles in the refrigerator.
- Use the smallest lancet you can find. Ask your doctor for suggestions. Length matters, too. Many pediatricians recommend 4mm needles for kids, but Dr. Kimball says her patients' preferences run the gamut of standard sizes -- 4, 5, 6 and 8 mm. "It's very personal and totally depends on what feels better to your child's body."
- Find pinchable fat, usually on the buttocks, arms, or front of thighs. Adults use the abdomen, but generally children find it too tender. Avoid the two-inch radius around the belly button, says Dr. Kimball, because that area doesn't always absorb insulin well.
- Use an ice pack first. Apply for a few seconds, which can briefly numb the area.
- Do it quickly. "Slow is never better with a shot," says Dr. Kimball.
- Rub the area after an injection. A rubbing motion is not only a distraction, it warms the skin, which helps the insulin absorb more quickly.
- Don't re-use needles. A needle is coated so that it glides into the skin. That coating goes away after one injection, says Dr. Kimball. Extra-fine tips also dull after one use.
Pump site changes
If your child wears an insulin pump, every few days you'll need to change where it goes into the body. "That can hurt," says Dr. Kimball.
To ease the pain, ask your doctor or medical team if a prescription numbing cream called EMLA would be a good option for you. You can apply this topical mix of lidocaine and prilocaine 30 to 60 minutes before inserting the pump tubing.
"I highly recommend this approach for parents with children who are newly diagnosed," says Dr. Kimball. "After a few weeks of using it, Sam told me he was used to the injections and didn't need the numbing cream anymore."
You can also try ice as an inexpensive alternative. "And remind your child that one poke every two or three days is still a lot better than lots of pokes every single day," she says.
Consider doing the site changes at night. "Never underestimate how deeply a child sleeps," says Dr. Kimball, who does this for her own son. She'll put numbing cream on Sam's new site, wait 30 minutes, and then do the infusion site change. Sam never wakes or remembers the site change in the morning.
"It's quick, there's no cajoling, there's no pain, and it's over," she says. "For a very young child, it can be a great solution."
Attitude is everything
Your own state of mind helps your child avoid needle fear. She'll take cues from you, so act confident and calm, even if you're feeling a little shaky. Talk to friends or your healthcare team when you need support.
Giving a child small choices also helps. "While your child should understand that it's not a choice to get insulin, he or she can decide between the left arm or right arm," says Dr. Laffel.
Focusing on the positive effects of T1D can help both of you, says Dr. Kimball. "It's so important not to pity a child with diabetes. Having diabetes will make your child a stronger person. It shaped who I am. I'm a much tougher cookie, much more independent and responsible, because of it. You can say to your child: 'Yes, this disease is a challenge. You were just given a lemon. Let's make lemonade together. Here, I'll teach you.'"
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