Seaside,

From all the reading I've done on this subject, but I'm no expert, higher doses of insulin will drive down blood sugars, thus reducing A1Cs. The problem in doing so increases the risk of hypos. However, being an average over a long period, A1Cs can be managed either by driving down fasting blood sugar via basal insulin, and watching huge spikes at meal time (without other controls), or managing meal time spikes via prandial insulin. I think Al has said that the best combination will be a basal insulin administered using a pump and real time monitoring and a meal time insulin to avoid the wild swings during and after meals. The latter of which is now being given careful consideration since the periodic high blood sugar levels following meals may cause a lot of damage over time, but hide in the comfort of the tried and true A1C levels that have been the target measurement for diabetes care for a very long time.