My seven-year-old daughter was diagnosed with diabetes two months ago. Her A1c was 10.1 then and is now 10.7. I often find her blood sugar is over 500 mg/dl [27.8 mmol/L]. I am very worried about her. Here, in Pakistan, medical care is not as good as that in the U.S. Where in the U.S. could I take my daughter for appropriate care? I have a visa, just need to know where I should take her for treatment. Also, should I consider an insulin pump for her instead of pen injections?

The A1c seems very high and it is puzzling why it would stay so high. This usually means insufficient insulin is being provided. I would suggest before and one to two hours after each meal checking of her blood glucose levels if this can be afforded. This will then give you information upon which to base doses of fast acting insulin at each meal. Then, most modern diabetologists working with children would give a basal insulin in addition to these meal boluses and one can use overlapping doses of NPH or the more expensive and somewhat better basal insulins like detemir or glargine (Levemir or Lantus). But all should be based upon frequent blood glucose monitoring with a meal plan that is balanced, provides some flexibility with carbohydrate counting or other means of balancing meals.

SB

[Editor’s comment:

The problem with getting an insulin pump is continuity of supplies. You would need to ensure that you can either have the pump company ship directly to you or have a relative or friend in the U.S. or Europe who could ship the supplies to you. You would also need to be willing to pay approximately $6,000 U.S. for the pump.
BH]