I was living in Venezuela when my daughter was diagnosed with type 1 diabetes when she was 4. She is now 7 and is very bright, full of energy and very positive. I haven’t had very good access to profesional help. The doctor I would visit was a days’ travel away so we would try to see him every 6 months. I have now moved to Curacao, a small island where there is only one children’s doctor with whom I have made an appointment.

I recently bought a Dexcom CGM and we try to keep her within the range of about 80 to 200 mg/dl [4.5 to 11.1 mmol/L]. My daughter is on injections. In the morning, we give her 15 units of Lantus. She also gets Humalog. She goes to school from 7 until 1:15. During this time, we don’t give her any insulin so sometimes she goes high. I have a nagging feeling I’m not doing enough. Should I be aiming for much tighter levels? When she is at school, should I find a way to give her insulin? At what point should we get a pump? It’s very hard when you are self funding the cost of the CGM and the Omnipod is like another mortgage. Am I doing the best job of looking after my daughter? Any advice would be greatly appreciated.

It sounds like you are very well motivated and educated and doing a good job with your daughter having such a positive attitude. Understanding Diabetes by Dr. Peter Chase and Type 1 Diabetes in Children, Adolescents and Young Adults by Dr. Ragnar Hanas are the two best books to get and read as a parent since they are excellent, comprehensive and up-to-date about your options monitoring, insulin, multi-dose-insuln regimen, pumps and CGMS. Dr. Chase’s book is available online. You should be able to find Dr. Hanas’ book on Amazon.

Most of us would recommend Lantus twice-a-day and not just once-a-day with sufficient blood glucose monitoring to guide mealtime dosing. This depends on affordability and availability of blood glucose strips. Optimal would be before and about 2 hours afer meals and occasional middle-of-the-night monitoring. If you are using the Dexcom, this fills in those gaps but it is expensive without insurance to pay for the sensors.

You should be able to do MDI treatment with 5 or 6 injections each day and get excellent results coupled with carbohydrate counting and analysis of blood glucose data so the extra expenses of an insulin pump are not automatically needed. If money were not the issue, or you had insurance to cover thse costs, the pump provides more flexibility, allows extended boluses with square or dual waves and the newest Medtronic pumps actually have sensors (Enlite) that communicate directly with the pump and provide automatic low glucose suspend if needed. DexCom sensors talk to some of the pumps but still do not communicate with any of the pumps although there are still rumors that this will occur. We wait to see the reality. You can go to the Medtronic website to get more current information.

Keep up the good work, use the blood glucose monitoring to learn how you are doing and maximize the benefits of MDI. Best of luck.

SB