Managing in the moment

Here is a quote from a d-parent I know:

"Our daughter has had type 1 diabetes for 6 years, her A1C runs as high as 8%. We've recently been using the insulin pump but can't seem to control or balance the blood sugars during activities or after changing the infusion site. Can you advise us on how to adjust the pump?"

Ok, reasonable and common concerns I've heard for years. And I certainly understand the intent. But the focus might better be placed somewhere else besides primarily on the device.

Patients and parents often tell to me they want to get themselves or their child "back in control" of their diabetes. Questions like these are often asked in a way that implies that I've got a secret I might be able to share with them. Fact is, there IS a secret formula for high quality type 1 diabetes control. I'm going to post that secret right here for everyone to see and share. But here's a hint: it has less to do with the prescribing of medications or devices.

Discussions about improving diabetes control too often revolve around finding or prescribing a different insulin dose, getting on or off an insulin pump, or changing the dosage settings on an existing pump. Too often it's just all about the insulin. Objective trumps the subjective. "If only we had _______" (fill in the blank).