Type 1 diabetes can be difficult to control in young children because of variations in food intake and exercise, the difficulty of administrating low doses of insulin, and frequent viral infections. These young children also have increased sensitivity to short-acting insulin and often cannot tell their caregivers when they are having symptoms of hypoglycemia. Pump therapy may be a more effective and safer way to administer insulin therapy in these children. Litton and associates studied the use of pump therapy in nine children younger than four years who had type 1 diabetes and severe hyperglycemia.

Family members received thorough education about hyperglycemia and hypoglycemia and were provided with easy access to staff members for questions or concerns. Dietary information was provided to all, and bedtime snacks were recommended. Initial therapy for all children included multiple doses of insulin during the day using long- and short-acting preparations. Blood glucose measurements were obtained four to 10 times daily along with urine testing for ketones daily and when illness or hyperglycemia occurred. Pump therapy was recommended for use in children who, after at least six months of injection treatment, developed recurrent hypoglycemia, persistent glycosylated hemoglobin (HbA1c) elevation, erratic variations in blood sugar levels, or recurrent ketoacidosis or severe hyperglycemia. Constant adult supervision is required for any child using pump therapy. Caregivers of children starting pump therapy were educated about its use and had to be willing to monitor blood glucose levels at least four times daily. Children had to be able to tolerate and avoid touching the catheter and the pump mechanism.