Question:
From Georgia, USA:
My daughter's blood sugars range from 37 to 350 sometimes in a matter of hours. Her A1C's have ranged from 8 to 18. We are considering putting her on a pump. Would we see a big difference in the control of her diabetes? She is 10 and has had diabetes for 6 years. She is good about not eating sweets, so it's the consumption of carb's or the lack of them that we see the big difference in her readings, or stress level. Sometimes we have no clue why her readings are what they are. Help! Would a pump help or not?
Answer:
Pumps can work fine in a ten year old, although this is usually
considered too young to start. However, they are very decidedly not a
solution to poor control. For one thing, experienced pump teams insist
that good control using one of the intensive insulin regimens be
established first. By implication, there is a need, especially in the first
weeks, to have frequent access to a really knowledgeable team, especially
in this age group.
This leads to the question as to why your daughters blood sugars
are so erratic. There is a drill for this which may require a lot of
perseverance to make it work. The first step is to set aside two or three
weeks when you will do a lot of blood sugars. These should be before
meals and before bed and with additional levels in relation to vigorous
exercise and an occasional one at 2 A.M. If you have a meter with a good
memory you can then get a printout either on your own PC or at your doctor's
office that will help with interpretation. An alternative is to record
all results and to fax them into your diabetes team each week, making them
responsible for interpretation. If you have to do this yourself, it is
helpful to make a histogram; i.e., graph out blood sugar levels versus day
of the week and time of day. Then you block out all results that are
between 80 and 180 mg/dl and start to look first at all the low values
and then at the high ones. With the low values try to see if there is a
relationship to missed meals or snacks or to exercise. With the high ones
think of dietary indiscretions and of course stress of any kind. Discuss
your conclusions with your doctor; but don't change the dose or kind of
insulin without consultation. Before you start all this, of course, you
should make quite sure that your technique and your meter are clean and
functioning correctly. Someday, I hope that we'll have programs that can
be installed on pocket calculators that will help to resolve this sort of
a problem.
DO'B
Original posting 29 Mar 97
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