My three and a half year old daughter, diagnosed with type 1 diabetes approximately six months ago, is on two injections day, and I check her sugar levels four to five times per day. Her latest A1c was 6.8%. We are considering changing her to pump therapy, and I am wondering if it is realistic to expect better control than what we have currently. She doesn’t have any problems with injections and does great with her meal plan so the main reason we would change is for better control.

I would say that if things are working the way they are now, there is no reason to change your regimen just because an alternative is available. Insulin pump therapy in children your daughter’s age is still quite experimental. In our experience with a randomized study of 40 kids under the age of 5 on pumps, there was no difference in blood sugar control (average blood sugars, numbers of high and low blood sugars, blood sugar variability) between those treated with injection therapy and those on pumps.

LAD

[Editor’s comment: The point about pump therapy in very young children being experimental simply means that there haven’t been many (or any) studies published about the use of pumps in children that age. It doesn’t mean that pumps aren’t used in very young kids, or that very young kids don’t benefit from pump therapy. Pump therapy also offers a level of schedule flexibility that is not always easy to achieve with multiple injection therapy, even if blood glucose control is equivalent.

JSH]