I’m not convinced that a pump will necessarily be the answer to all your issues – most of the clinical research has proven that the biggest benefits of pumping are realized in people who have poor control to start with (A1c’s of 9 or more), their need for basal insulin varies significantly throughout the day, or they need dosage precision greater than 1/2 unit (they’re very insulin-sensitive). However, for smoothing out the peaks and valleys, you might consider adding Symlin to your treatment plan – once you get over the nausea, many people have found it works wonders as far as smoothing things out.
Also, you should know that JDRF-funded studies find that even intensively managed people – doing 9 fingerstick tests daily – spend less than 30% of the day in a target glucose range (70-180mg/dL). Similarly, the NIH-funded DirecNet found that children with an average A1c of 6.8% – which is still decent – still spend nearly 9 hours per day above 180mg/dL. The key is that glycemic variability is significantly higher in type 1 than it is in type 2.
Dr. Zach Bloomgarden, a New York City endocrinologist with a huge clinical practice (over 1,000 patients) and is noted for his many articles on diabetes (nearly 250), and has also written over 150 columns, “Perspectives on the News” for Diabetes Care since 1994 described it this way:
“Type 1 diabetes is a hugely different burden from type 2 diabetes, and the easiest way to quantitatively understand that is to have a thousand patients or so with diabetes that you treat for years and download their meters day after day after day – when you do that, you’ll find that the standard deviation of the blood sugars in a person with type 2 diabetes is 10 mg/dl or 20 or at most 30 or so. The standard deviation of the blood sugar of someone with type 1 diabetes is at least 50 or 60 and often 90 to 100. So that translates into just huge, huge variability in blood sugars.”
The simple fact is that variability is more the rule than the exception with type 1, so don’t feel like your alone on this, or that its somehow not normal. Chances are, someone claiming not to show that much variation is probably not being honest. Carb reduction will reduce the variability somewhat, but the question is whether you really want to live with that kind of dietary limitation?