My 11 year old daughter and I are more than willing to do the work involved in starting an insulin pump. However, because my daughter’s A1cs have been 6.6 and 7% on three shots, her pediatric endocrinologist doesn’t think we should change. He said he would be more likely to put her on if she had bad control. I think we could get better numbers with the pump. Should we just back off on our interest in the pump?

Your pediatrician is correct that the hemoglobin A1c levels you report are excellent. So, the answer to an insulin pump depends upon what goals you would like to achieve. Often, pump users have fewer and less severe episodes of hypoglycemia. Sometimes, there is clearly more convenient insulin coverage with a pump compared to injections. Sometimes, there are still problems overnight with insulin that does not last sufficiently long, causes overnight hypoglycemia or dawn phenomenon problems when insulin is waning.

You should discuss all of this in some detail with your diabetes team and then decide what makes sense based upon some more detailed monitoring before and after eating and also through the night.

SB