My 13-year-old son stared using a insulin pump eight months ago. His A1c is getting higher and higher, now 12.1. He is getting 26.6 units for his basal. His bolus average is four to eight units. His 14 day average blood sugar is around 120 mg/dl [6.7 mmol/L] to 123 mg/dl [6.8 mmol/L]. Should his bolus and basal be 50/50? I know he does not bolus correctly. He says his basal will cover it. Could this be causing his high A1c?

There are several issues that need to be addressed. First, an A1c of 12.1 correlates to an average blood sugar of approximately 350 mg/dl [19.4 mmol/L]. He may be not testing, testing someone else, or using control solution to get those numbers. Downloading the meter to look at all the data at one time will help to solve the mystery of mismatched A1c and meter numbers.

When initiating pump therapy, we see many people start with a 50/50 basal bolus ratio, then adjust from there. Teens can vary anywhere from 60% basal and 40% bolus to 40% basal and 60% bolus. Your son is far enough off that he is just not bolusing for his meals. The theory of pumping insulin is based on the fact that each time he eats, he boluses based on the carbohydrates (and excessive fat and protein) that he consumes. The basal is not meant to cover meals or even snacks.

Dr. Howard Wolpert’s book, Smart Pumping, can help you, as a parent, and your son, as a teen, understand the theory and practice of dosing with a pump.

Right now, your son’s blood sugars are running dangerously high. Your family needs to go into his doctor or CDE and address these issues now.

NB