There are excellent reviews to guide the initiation and management of insulin
therapy to achieve desired glycemic goals (1,2,3). Although most studies of MDI
versus pump therapy have been small and of short duration, a systematic review and
meta-analysis concluded that there were no systematic differences in A1C or severe
hypoglycemia rates in children and adults between the two forms of intensive insulin
therapy (4). A large randomized trial in type 1 diabetic patients with nocturnal
hypoglycemia reported that sensor-augmented insulin pump therapy with the
threshold suspend feature reduced nocturnal hypoglycemia, without increasing
glycated hemoglobin values (5). Overall, intensive management through pump
therapy/continuous glucose monitoring and active patient/family participation
should be strongly encouraged (6–8). For selected individuals who have mastered
carbohydrate counting, education on the impact of protein and fat on glycemic
excursions can be incorporated into diabetes management (9).