Children with type 1 diabetes who normally receive four to five insulin injections daily now have access to an alternative treatment via an insulin pump and attend to a dedicated “pump school” to learn 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 treatment is currently available to all suitable children with diabetes in Cork city and county; with children under five years of age being prioritized as part of the HSE’s National Diabetes Clinical Programme. The children and their parents are trained to use and manage the insulin pump at a dedicated “Pump School” which is a structured education programme delivered by a consultant led team from Cork University Hospital (CUH). This is the first dedicated Pump School for children 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; one full day followed by a half day a week later. During the first week the child is attached to a pump consisting only of salt water. The child wears the pump for a full week at home to get used to it and to identify any issues before starting on the insulin pump. 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 PumpSchool service in Cork. The team is comprised of two consultants (both appointed in last 18 months) 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 at CUH and national lead for the National Diabetes Clinical Programme said “Insulin pump therapy has evolved considerably in recent years and is now considered the gold standard of children with type 1 diabetes. However pump therapy is not for all and careful patient selection is at the core of successful pump starts. Pump therapy improves blood glucose control and quality of life and reduces the less 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”. 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 family friendly approach in a child and family friendly non-hospital environment. There are over 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. 20 children have already commenced on pump therapy in Cork which is proving very beneficial and it is envisaged 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 and 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 in our services inCork”. Kieran O’Leary, CEO of the Diabetes Federation of Ireland 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”.
