My 12 year old daughter has had type 1 diabetes since she was 18 months old, and we have a hard time managing her sugar. We test four to six times a day, and it’s never right. Do you think I should talk to her doctor about a pump?

First, I would make sure that she wants to wear the insulin pump and that her reasons for doing so are reasonable by adult standards (e.g.”because I want to be able to eat when I want” rather than “because it looks cool”). Twelve is an age where some children will readily take to a pump, but others may resent it since it requires a great deal of work and “identifies” them as having diabetes to their peers. Since she will be responsible for the pump most of the day, she needs to want to work with it.

Second, you and she will need to know how to do carbohydrate-insulin ratios and corrective doses as a way of determining her insulin doses. This should be learned before she goes on a pump – since it makes the transition to pump therapy much smoother and the advantages of pump therapy more tangible. You should also provide diet records to your dietitian to make sure that your carbohydrate counting is being done correctly and to help ease the transition onto a pump (since the records will provide a great deal of information about her eating and activity patterns).

Third, you’ll need to consider how affordable the pump will be and which of the various pump models that are out there is best for your family (depending on which ones your insurance will allow) –

If all those cards fall into place, pump therapy may prove to be a great option – If they don’t, perhaps starting with carb-insulin ratios will make enough of a difference to bring her diabetes into better control even without introducing new technology.

LAD