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August 20, 2000

Daily Care

Question from Toronto, Ontario, Canada:

I'm 16 years old, and have had diabetes for almost two years. My question relates to treatment options. For the majority of my first year with diabetes, I was taking three shots a day. However, after a HbA1c of 8.8%, I switched to Intensive management, and got my HbA1c in the 7's (7.0-7.4%). With this better control, I have been going low very frequently (five to eight times a week), and have now been considering a pump. Is it good for me, or anyone to constantly change their routine after a relatively short period of time? I mean, I don't know if I should be jumping from one treatment option to another, or if I should stay and work with one. How long do you usually recommend your patients to try a treatment option before switching to a new one?

Answer:

I would recommend using whichever treatment gives you the lowest HbA1c, fewest high and low blood sugars, and best fits your lifestyle. Most frequently for teenagers, an insulin pump with proper training probably will best meet your needs. In combination with the new glucose sensor (CGMS) it is possible to intensively and accurately manage your insulin dosing to best meet your needs and provide you with the level of control you are interested in. I would not hesitate to look into insulin pumps in your situation.

MSB