Three children with diabetes from the same family, who had to take up to 15 insulin injections every day between them, have been given a new lease of life thanks to insulin pump therapy.
An insulin pump is a portable computerised device that is attached to the body. It is the size of a small mobile phone. It delivers continuous amounts of insulin 24 hours a day through a catheter that is placed under the skin.
The amount of insulin provided is based on the requirements of the person using the pump and this can be altered.
Siblings Ben (9), Emily Mai (7) and Harry (4) Ryan from Tipperary all have type 1 diabetes and attend Cork University Hospital (CUH).
Ben was diagnosed at the age of two at South Tipperary General Hospital. His mum Jane became very adept at managing his condition, so if his siblings became sick, she used to check their blood sugar levels ‘just to rule it out'.
As a result of these checks by their mother, Emily Mai went on to be diagnosed with type 1 diabetes when she was four, while Harry was diagnosed when he was two.
By 2011, the three children were receiving insulin injections twice a day and the condition ‘was controlling their lives', Jane said. For example, she had to go to school and playschool to give them their injections, and birthday parties and play dates were out of the question as Jane had to carefully monitor what they ate and match this to their insulin intake.
The children were referred to CUH consultant paediatric endocrinologists, Dr Stephen O'Riordan and Dr Susan O'Connell, who lead a multidisciplinary team that includes diabetes nurse specialists and dieticians.
In the beginning, the children's insulin injections were increased to five each per day, to give them more independence in relation to what and when they could eat. Both parents were also educated about the importance of reading food labels and counting carbohydrates correctly.
"Together at home, Jane and dad Richie put their counting skills to practise and were extremely fast learners at the skills needed to measure and count all carbohydrates eaten. They have always been incredibly positive and very open to learning about the food in order to improve the daily management of type 1 diabetes," commented paediatric diabetes dietician, Shirley Beattie.
According to Jane, administering 15 injections on a daily basis took a lot of effort, however a phone call last year changed the family's lives.
"A phone call from diabetes nurse specialist, Norma O'Toole, has since completely changed all of our lives. Norma told me that the team was ready to offer insulin pumps to the three children, which meant the injections could stop," she explained.
According to Nurse O'Toole, it was the ‘positive, can-do attitude' of Jane and Richie Ryan that resulted in the children being candidates for the pumps ‘and that enabled all three children to start on pump therapy together'.
The pumps were tested on the children over the course of a weekend - blue for the boys and purple for Emily Mai - and all three children were happy with them.
Following this, the children, their parents, teachers, special needs assistants, an aunt and a friend all attended ‘pump school', a dedicated education programme at CUH, which aims to teach people how to manage an insulin pump.
"It was very intense, but they gave us a fantastic manual that we can consult at home for step-by-step instructions to follow when for example one of the children is sick or has high sugar levels," Jane noted.
Intensive support was provided to the family in the beginning, but by week three, the children were well established on the pumps.
"We are now controlling the diabetes rather than the diabetes managing the children's lives. I don't have to appear at the schools daily, they can go to parties and on play dates. They can eat what and when they like as they know how to check their blood sugars, check the label to count the carbs and input the data to the pump.
"The pump will diffuse the necessary insulin based on these details. At night I have to check in on the children less often and only wake them occasionally to take some lucozade to regulate the blood sugar level, compared to when they were on the insulin injections," Jane explained.
None of the children have been admitted to hospital since starting on the pumps.
According to Dr O'Riordan, it is unusual, but not unheard of, to have three children in the same family with type 1 diabetes, however he described the family as ‘very easy to work with'.
He pointed out that pump therapy improves blood glucose control and the quality of life of those using it. It also reduces the risk of long-term complications linked with diabetes, such as heart disease, kidney failure and blindness.
"Insulin pump therapy is not for everyone, however all families can be assessed for suitability and careful patient selection is at the core of successful insulin pump service," he added.