2 year old - pump reccomendations

Hello everyone. My son was recently diagnosed with T1D about a month ago. Things are going well and we are figuring this process out :-).
I have searched the forum and found many older posts regarding this question and I am not finding anything recent in the last 5 years so I am going to ask again.

We are in the process of getting the Dexcom G6 CGM. I am wondering what everyone’s recommendation is for a pump for a 2-year-old. I have looked at the Omnipod, however, it is not covered with our insurance. I am hoping to get some good information on what your recommendations would be for the type of Pump to look into?

Hi, @Aaronbecker, and Welcome to the Type One Nation Forum! I’m sorry to hear about your little guy, but very glad he’s doing well, and that you’re figuring it all out. There’s a lot to learn, that’s for sure.

There are lots of posters here with way more experience than I have, so I hope you hear from other folks with littles. That said, there are only three pumps on the US market: Tandem, Medtronic, and Omnipod. I think Omnipod IS the first choice for lots of families with small kids (waterproof and tubeless definitely make life easier), but plenty of people have had success with both of the others for their children. Heck, lots of posters here had T1D before there were pumps at all, and they’re doing great.

Get in touch with reps from each, and have them figure out what your financials would be with your insurance, and talk to you about their products.

Also know that your doctor can fight for you to get coverage of something your son needs, even if the insurance company doesn’t normally cover it. It’s a tremendous hassle, though, so I offer that only if it really matters, which probably it doesn’t. The truth is, any way your son gets insulin into his system is good.

If you search “Tandem Medtronic kids” on this site and then sort for most recent posts, you’ll see tons of threads with people talking about the differences between them. Here’s one, for example:

And here’s another:

But there are tons more. Browse around, ask us anything as you think of more questions, and remember:

You’ve got this!

The other two options are Medtronic (Minimed) and Tandem T:Slim. There are lots of discussions on this pumps even if not related to infants, but you still might find it helpful. I switched from Minimed to Tandem around 10 years ago - at the time they had pretty much the same features - I just preferred the sleeker look of the Tandem. Both now work with CGMS which can provide readings the pump can use to adjust insulin flow as needed. Tandem’s CGM works great for me - I’ll let you do your own research here and elsewhere to see what people feel about each. A CGM can be used by itself - to give readings and allow the user to make adjustments to insulin, whether via pump or injection.
If you don’t mind me asking, why are you starting on a pump when he’s so young? I’m a great advocate for pumps but some people do just fine on injections. This is my personal opinion but I believe it’s good to be proficient at going “old school” unless there’s a serious need to jump to the more advanced tools. I myself took injections from age 3 through my mid 30s. The fine gauge syringes weren’t available until I was older but I adjusted to shots from a very, very, very young age, and I’m sure they are much less painful now.
Not to question your maternal instincts - I’ve read on the forum about young kids who use pumps successfully. Keep in mind, if a pump begins dislodged your getting no insulin and glucose can rise very fast. With injections you know the insulin went in, and there is long acting insulin in the background which helps at least somewhat of a dose of insulin for meals is late or omitted.
If you haven’t already done so have a team with your son’s endo so you can be sure of the pluses and minuses (one of which is also cost). When I started pumping I think they were not recommended for young children (much less infants) so I naturally lean that way, although to be fair kids are using them now.

Thanks for the reply!

We are new to this and still learning, and the main reason for us researching a pump is since he is so small, his body doesn’t use much insulin and the shots are rounded to half units. Currently, the rate is 1u/28 carb and 0.5u/100 BG correction. Our thought is we have to round down so often and that if we had a pump we can dose more closely to what he actually needs and control the swings better. Secondly, since he is only 2, our biggest challenge is guessing what and how much he is going to eat. our thought is we could give him some insulin to get it working, and then if he decides to eat more, we could administer more insulin without having to give him another shot.

thanks again

thank you, I will continue to research these posts and topics. I appreciate the response.

As you are doing your research be sure to ask about minimum fill for the cartridge and about “reclaiming” unused insulin. I don’t think reusing is recommended so do check and see if it’s something you are comfortable with.
I believe Tandem requires at least 90 units in the cartridge - not to mention what goes into the tubing. That’s perfect for me - I keep an infusion set in for 3 days and use around 30-35 units a day; I imagine your little one would use much less (but that’s just a guess). I myself have pulled out extra insulin to use in another cartridge (and I’ve read on the site where others have as well) but I’m an adult with lots of diabetes experience so if there are risks I’m okay with taking and managing them.

Thanks, I will keep that in mind when researching. You are correct, he uses a lot less being only about 30 lbs. He only uses about 6-8 units per day currently…

Hi, my son went on a pump when he was 17 months old, in part for the reasons you noted (difficult to syringe-dose accurately on a small body.). I can confirm that a pump with a toddler is very manageable and vastly preferred, for example when you have to bolus in the middle of the night.

One practical aspect that I will just mention — is how the child will wear the pump. I don’t mean where to place infusion sets, I mean “wear” the pump. Since not too many toddlers have clothes with nice deep pockets or wear a leather belt to keep their pants up, ha ha !

For my son, at the time he was on Medtronic and they sold small soft pouches / bags with a stretchy belt that buckled at the back, and the belt could be trimmed to size. These were a great product. Even as a small child my son wore these under his clothes and adapted well. Last time I bought a Medtronic bag, they had changed the design so the pouch had a rigid frame and was not comfortable at all. Tandem does not seem to carry pouches for the T-slim pump, they seem to favor this little clip device, I think in part so that the communication between the pump and a Dexcom (if in use) is not impeded.

There are some other makers out there with various cases etc. I just wanted to mention this point because in all the “glamor” of the pump … you still need to figure out a way that the toddler is not dragging it behind them, attached to 23 inches of tubing as they charge towards the swing set …

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Hi, It’s a big decision! I use a flip belt, it stretches, that I can wear on my waist or hips to hold the pump and it can also cover the sensor. I use the Dexcom G6/Tandem t:slim combination. They can be wonderful, but I’ve also had problems with infusion set and sensor failures. They’ll send you replacements for free, but you still have a high BG problem that needs to be taken care of manually. Your endo can help you with a protocol to follow when this happens. The advantage is better BG control and more sleep for both of you. Take care!

:blush: - excellent points! You might have luck on Etsy.com depending on what you’re looking for.

Hello! Our 21-month-old has been pumping with the t:slim since January. He wears the pump in a SpiBelt (can purchase online!) fanny pack made just for T1D kiddos, and it works really well. Our toddler also wears a Dexcom sensor. The pro to this combo is Basal IQ, which can prevent some lows by shutting off basal when BG reaches a set #.

Since we don’t use an Omnipod, I’m not as well-versed in its features. I do believe you can dose remotely for the Omni, which would mean you could dose your toddler as he runs past you on the playground, or from outside his door at midnight while he snoozes.

I would suggest to stay away from Medtronic until they’re willing to work with Dexcom or able to provide a CGM with remote viewing, otherwise you have to physically touch the Guardian CGM to see your kiddo’s BG, which is tricky with an active toddler.

And now for some words of encouragement! You’re rocking this. T1D parenting is tricky and can knock you down, but it’s a road well-traveled and there are lots of cool people along the path.

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