Highs & Lows can appear out of nowhere!
They come out of nowhere sometimes and there seems to be no rhyme or reason. I know there probably is something: growth spurt? low-level asymptomatic illness? change in the weather? poor sleep the previous night? hormones/puberty? full moon?
N my 11-year-old with T1D has been amazing for the past six months. He is handling it all with good humor and some resignation. I know he isn't "sneaking" food or forgetting to bolus because there isn't a need for him to sneak and we make sure there are always two brains working out a bolus. We are trying to teach him good habits to take care of his chronic health condition because someday he'll be out on his own and we won't be right there anymore.
N likes cereal for breakfast. I know, I know, there are better options but we've been assured (repeatedly) that he can and should eat what he wants and cover the carbs. What I mean by better options is that there are carbs that have less effect on the range of blood sugar, the spike and fall. High fiber, lower carb meals work better for that post-meal spike and several hours of blood sugar stability and we know this but we also know he is 11 and he likes cereal and he can have it. He doesn't eat fruity choco marshmallow whatever, he eats a whole grain cereal but it is still cereal. He gets his bolus and we wait 25 minutes to give his breakfast of 30 grams of carbs and a protein. About an hour later his blood sugar goes up out of range but it usually comes back down within an hour. This has been his norm for the three months we've been "distance learning" by staying home. Same meal every morning. The boy likes his routines!
We've tried adjusting the time between the bolus and the meal and 25 minutes is about it. If we wait too long he has a low followed by a spike and if we give food too early the spike stays elevated longer and the peak is higher so 25 minutes. Until two weeks ago. Two weeks ago the spike was 100 BG higher than previously! It also spiked up and stayed up for 3 hours. It came back into range about twenty minutes before his next meal & bolus would occur.
The other thing we noticed, about the same time, is that his lunch bolus isn't working quite as well and there is a weird drop and raise between lunch and dinner. He gets lunch at about noon and we can only give insulin every three hours due to insulin on board and not being on a pump or calculator that can help us. To avoid "stacking insulin" we've been told to wait 3 hours before correcting with insulin or bolusing & eating. So he eats at noon, has a smaller spike that is on the high side of in-range for him at 170-180, sometimes out of range but lasting less than thirty minutes above range. Then at about two hours & forty minutes his blood sugar falls to the lower end of his range to around 100. He doesn't usually want an afternoon snack; probably because he isn't going to school and working up an appetite. He could have insulin at 3 but he often doesn't want a snack and he is in-range so none is needed. Then he spends the next hour with a steady glucose rise until he is out of range and he stays that way until dinner at 6. I know, I know, I could give a correction but then I feel like I have to push dinner back or worry that I'm stacking insulin. Ugh!
We have our math, ratios, corrections, factors, etc. We do the math as we've been taught and most of the time it works out. But for two weeks now we've had this nonsense that makes me wonder what I'm missing. Thankfully we can send in our numbers to the medical team at the Children's Hospital and get a professional opinion but I sent in numbers this morning by 9:30 and haven't heard anything back from them. Since it is Friday, I assume I won't hear anything until Monday.
So we'll keep doing what we do. We may swap out some preferred foods for less preferred ones for a few days to try to get things back into a more preferred pattern. Our CGM lets us look at our graphs and helps us check for patterns. It also makes suggestions for ways to adjust when a pattern emerges and we've used this to change our long-acting insulin dose over the past week but it hasn't changed the daytime pattern and we are starting to see midnight lows again so we are holding.
Type 1 Diabetes is just an uncooperative toddler that follows rules when it feels like it and shakes them all up when it doesn't. Here's hoping we aren't heading into a pattern of return to the 3 am club. Right now his glucose is in range less than 80% of the day even with corrections every three hours, and at night he is dipping below range between 11:30-12.
I guess this is why I drink so much coffee, or wine...