My three year old daughter is in full-time daycare, and also her blood sugar level is not as steady. Would a pump be a good idea? Do you think she would be a good candidate? Would a pump be a good idea?

There is no “right” answer to your question — just as there is no good answer to the question of who will succeed or fail on pump therapy.

First, I’d make sure that you’ve maximized your knowledge and the way you’re using injected insulin. You should make sure that you’re carb counting and using carbohydrate/insulin ratios and corrective doses. You need to understand how insulin works and how to trouble-shoot illnesses. You would need to ensure that her daycare providers are also comfortable with calculating insulin doses and trouble-shooting when necessary (able to check blood sugars and urine ketones).

If you’ve done all that, her numbers are still erratic, and you’re still thinking about an insulin pump, it would be important to discuss your daughter’s diabetes with members of a health care team that can manage a very young child on a pump. This is because just as the blood sugar target ranges are different for toddlers, the insulin requirements of very young children on pumps are very different than in older individuals. A few centers are doing studies in pump therapy in very young children; some others are gradually gaining experience as pump therapy becomes more popular.

LAD