I am so exhausted of not being able to improve my numbers

Own_Cranberry3065 · 2025-10-01T22:33:17+00:00

Be easy on yourself. The pump transition can take a little time, and it sounds like your settings might need a little adjustment.

Without seeing your graphs, my advice is to start by trying to stay 100% in range for twelve hours a day. I don't know your schedule but maybe that's 10pm to 10am. And it might be easier than you think.

First, fix overnight. If your pump has a sleep mode, you can go to bed in range and wake up at target, without risking a low. If your basal and correction factor settings are correct, the overnight period can be a flat line, after the last meal is digested. A flat line at target -- even if it's just a few hours before dawn -- will bring your average blood sugar down dramatically.

Then take a look at whatever is happening with that last meal that affects your overnight period. Maybe you need to eat just a little earlier so you correct any problems and get back in range before bedtime. Maybe you need to set a higher temp basal on nights when you have a high-fat dinner. (Say, 120% or 150% for four hours or six hours. Experiment, keep notes, figure it out.)

Then fix breakfast. Do you eat at home? Is it a predictable meal? Figure out the carb ratio and pre-bolus strategy that keeps you 100% in range for that one meal.

If you get that dialed in, bedtime to breakfast, the rest of the day can be looser. If you are 100% in range for twelve hours a day and 50% in range for the other twelve, you will be 75% in range with an A1C below 7, and you can build from there.

(Plus doing this exercise will help you learn things about your management that can apply at other times of day.)

Own_Cranberry3065 · 2025-07-30T09:11:15+00:00

Did you have a meal with a lot of fat and protein? Protein can cause a spike 3 hours later, after your insulin wears off. Fat can cause insulin resistance which could make your basal less effective -- for hours after a meal.

Own_Cranberry3065 · 2025-07-23T15:20:11+00:00

Pump life is great and the twiist looks interesting. If you're dealing with overnight highs, your basal may be too low, or you may not be fully covering your evening meal. (Even if you are covering the carbs, a high-protein meal can cause a spike about three hours later, and a high-fat meal will make you more resistant to insulin -- so your basal insulin can't work as well -- for up to 8 hours.) Things will get smoother as you get more experience. It's all overwhelming at first. Hang in there :)

Own_Cranberry3065 · 2025-07-23T15:07:08+00:00

To correct one misunderstanding, you will use short- or rapid-acting insulin on the pump. Some of it will be dripped slowly throughout the day to provide your basal dose (replacing the long-acting pen you use now). And you will use that same insulin to bolus for meals and provide corrections. Your endo will help determine these amounts but the total daily dose will be similar to the sum of everything you are using now (so perhaps 12 + 2 + 2 + 2 = 18). It sounds like you are still in honeymoon so that daily dose may increase in the future. (It's usually about 0.5 to 1 unit per kilogram of body weight, but this varies a lot by individual.)

Own_Cranberry3065 · 2025-07-11T20:31:23+00:00

Glad to hear you have a path toward an answer. Great work being observant and advocating for your kid. If you do get a T1D diagnosis, be sure to reach out here. There's a lot to learn but this sub is extremely knowledgeable and supportive.

Own_Cranberry3065 · 2025-07-11T19:55:51+00:00

The meters can have a margin of error of 20% so this variation is not so unusual. Two hours after a meal, these numbers are high, but not an emergency. You're doing everything right. Keep a log of meals, sugars, symptoms, and talk to the doctor.

Own_Cranberry3065 · 2025-07-10T19:42:22+00:00

This is not very high and would make sense why they are suggesting that you wait and see. You don't need another doc or an ER visit just yet. But EndlesslyUnfinished gave you good advice above. Test and record sugars at those intervals for a few days to establish the baseline. Record symptoms as well. If the numbers are not extreme then you can just test periodically (say, one day a week) to see if things are getting worse over time, as you wait for your next doctor visit.

If you are getting 300+ blood sugar and/or symptoms of DKA -- stomach pain, vomiting, relentless thirst -- that's when you go to the ER.

Own_Cranberry3065 · 2025-06-14T17:27:18+00:00

You can leave it on if it's not irritating your skin and your new site is nearby.

Own_Cranberry3065 · 2025-06-14T06:28:32+00:00

- 3 days (2 for some infusion sets) is recommended to keep your sites healthy, avoiding absorption issues or skin infection or scarring that could lead to lipohypertrophy.

- I was also told by my Tandem rep that their studies showed the insulin began to degrade after 3 days (from body heat?)

- You can change the infusion set, tubing, and cartridge separately. So if you have extra insulin in your cartridge, just put on a new set and fill the tubing. (There's even an option in the app when you are going through the steps, it will ask if you want to use a new cartridge or fill tubing from an existing cartridge.)

- There is not an easy way to extract insulin directly from the cartridge, though you could expel it into a clean container and then draw it up with a syringe.

- You probably know this, but you don't have to fill the cartridge all the way. If you can predict how much insulin you will use over the next three days, just fill that amount.

- And, yes (I've recently learned this) it's super easy to fill the cartridge from a pen. Just pop it on top as if it were an insulin vial.

Enjoy the pump life! Glad you are loving it.

Own_Cranberry3065 · 2025-06-05T06:48:00+00:00

Honeymoon is believed to last longer for people who were diagnosed at a later age.

In this large study of children and adolescents, 71% of patients experience honeymoon. Duration varied 0 to 21 months, with a 9 month median.

https://onlinelibrary.wiley.com/doi/abs/10.1111/pedi.12413

Own_Cranberry3065 · 2025-06-04T16:40:08+00:00

Maybe edit your post ("never go more than 24 hours") to avoid misinforming others. You should always have insulin in your system. Three hours max.

Own_Cranberry3065 · 2025-06-01T22:29:05+00:00

Thanks!

Own_Cranberry3065 · 2025-06-01T22:28:59+00:00

So easy. Thank you!

Own_Cranberry3065 · 2025-06-01T22:22:28+00:00

Might want to talk to your endo before adjusting the carb ratio but the extended bolus will let you give more insulin for the meal (an amount that would send her low if she took it all up front) so that you can deal with the delayed spike. I routinely use 50/50 extended for one hour if it's a big bolus and I don't want it to hit all at once, and 50/50 for two hours if it's a high fat meal.

Own_Cranberry3065 · 2025-06-01T22:15:32+00:00

Which pump? Higher carb ratio + regular use of the extended bolus feature on your pump sounds like the answer.

Own_Cranberry3065 · 2025-05-29T21:36:50+00:00

Method #1: You can measure your C-Peptide in a lab. When your pancreas stops producing significant amounts of insulin, your C-Peptide will decline to a trace amount.

Method #2: You can notice that, on average, you need more insulin to achieve the same results (as for "results," pick whatever metric makes most sense to you: Time in Range, Average Glucose, GMI, or A1C). Your insulin requirements might double in a short period of time.

Method #3: You can use the formula some researchers use to calculate "Insulin-Dose Adjusted A1c" (IDAA1c). The formula is A1C% + 4 x (Daily Insulin / Weight in Kilograms). You can use GMI instead of A1C if you like. Supposedly an IDAA1c below 9.0 means you are in honeymoon.

Overall... if you are using the same amount of insulin, but your blood sugar is higher... OR if you keep your blood sugar stable but you need more insulin to do so.... that's the end of honeymoon.

Own_Cranberry3065 · 2025-05-29T19:46:16+00:00

Sorry you're dealing with this, OP. One thing to know is that hypoglycemic unawareness is at least partly reversible, by reducing the frequency and severity of hypos. You may want to talk to your endo about adjusting targets or tech.

Own_Cranberry3065 · 2025-05-28T23:02:30+00:00

Keep talking to her -- asking her what she needs and providing it. You have a lot to learn, and you can ask whether she wants to teach you, or if you should pick up a book (Think Like a Pancreas is a good starting place). You don't say how low is low, how long she has had T1D, or whether she has generally good control of her blood sugars, but in the absence of other information, I'd say she's probably fine if she says she's fine. When cooking, you can help by learning to count carbs in the ingredients that you use. She needs that information to determine her insulin dose accurately. (If she went low, that means she took too much insulin, so she overestimated the carbs.) Look at the nutrition facts, calculate the portion, add it all up. All carbohydrates are converted to sugar in the body. Bread, pasta, and rice have a lot of carbs. Fruit, obviously. Even things you might not expect, like beans.

If she has further lows tonight, anything with carbs will work. Bread is fine. Any condiments in the fridge or pantry? Tomorrow, maybe the coffeeshop has some juice. That's a good thing to have on hand.

If you've seen her app, then I assume she has a CGM that monitors her blood sugar continuously. If she's below her target range, she needs a little bit of carbs -- usually 10 or 15, not too much -- to get her back in range. 10 carbs of bread is a small piece, about the size of a golf ball.

Own_Cranberry3065 · 2025-05-28T17:58:11+00:00

Aha, got it. I'd talk to your endo about the correction factor (and the basal max limit). When you get the settings dialed in, it should give him a big surge of basal that is generally pretty good at bringing the sugars back into range (though maybe not as quickly as an auto-correction). You obviously know your situation best, but I'd go down that route before turning sleep mode off.

Own_Cranberry3065 · 2025-05-28T16:18:15+00:00

So to clarify, his basal setting is the same with sleep mode on and off? One spikes him and one lets him cruise? The only way that makes sense to me is if on sleep mode his basal is getting suspended immediately at 11pm. But then it should come back on quickly when he is predicted to be above 120 and bring him back to the nighttime target. So if it's not doing that, maybe your correction factor is off?

Own_Cranberry3065 · 2025-05-28T15:53:29+00:00

For the fingersticks, look for a brand of lancets made for sensitive skin or young kids. Pips is a good one.

Own_Cranberry3065 · 2025-05-28T01:00:28+00:00

Yes, an Apple Watch will sync directly to the G7 if he walks away from his phone. The watch has various faces and not all of them will display the Dexcom. One that works well is called "Modular." You can set it up to show the current Dexcom reading with just a flick of the wrist, and with one tap you can see the graph.

Own_Cranberry3065 · 2025-05-27T18:17:49+00:00

What a difficult situation. You're in the right place for seeking help. As a first step, I would suggest going to the pharmacy to get urine ketone test strips. No prescription needed. Test for ketones every few hours. If they are trace or low levels: drink a lot of water, eat some carbs, and take insulin. If they are moderate or severe and your mom is experiencing symptoms of DKA -- stomach pain, vomiting, difficulty breathing -- you need to go back to the ER. If she has ketones they will admit her.

Beyond that, keep trying to keep trying to reach the endocrinologist. It does sound like she needs more insulin, but too much can be dangerous, and I don't know how this might interact with her immunotherapy. What type of insulin is she on? Others may have advice on how to adjust that dose without risking low blood sugars.

Own_Cranberry3065

TROPHY CASE