Daily Highs or Nightly Lows

While we continue to wait for our son to be approved for an insulin pump (yes waiting and waiting), we are continually trying to manage the ever changing demands of his T1D.  Of course we have the honeymoon period of diabetes that was giving us the sense that things were in pretty good control then we got the CGM and realized that things were in control every 3 hours but in between they were fluctuating wildly.  Now we seem to be going through a period where our current ratios and corrections aren't working and things need to change.

Since we have the Dexcom, we get to look at his patterns over days and weeks.  As someone with a background in managing data and making adjustments to affect change this was right in my wheelhouse.  Unfortunately, waiting 14 days between changes has not really been my forte.  Our medical team really likes to see a pattern that lasts over 10 days before making an adjustment to his basal insulin or even his daily ratios.  I feel like we should be making adjustments a little more frequently than that.  So, we fall somewhere in between. 

We've been increasing N's basal (long acting) insulin over the past two weeks.  He has a pattern of daytime high blood sugars.  His BG starts rising from the moment his feet hit the floor in the morning until his breakfast insulin kicks in.  Then three hours later, when the insulin should be about done and the food should be about gone, his BG starts rising again.  It also rises whenever he is exercising.  It rises and rises.  For several months we would go days without having to give a correction, just covered carbs at meals and we were good.  For the last month we've had to give correction every 3 hours all day long and at least once in the middle of the night!  So up we go with the basal insulin.  Each time it is adjusted the other ratios end up needing adjusting too.  So this process takes several weeks to get a new balance.

Well our new balance is one of the following: we can have basal at level X and he has daytime highs or we can have basal and level Y and we get nighttime lows.  Apparently we can't be in range for both day & night.  I know when we get on insulin pump therapy we can set different basal rates for different time periods so I'm looking forward to that but for now I'm stuck with high blood sugar during the day but a nice steady line through the night or in-range blood sugar during the day with a falling line and a need for a snack in the wee hours of the morning.  I'm opting for the 2 a.m. snack right now since I know the long term effects of high blood sugar and because our son does have a CGM that wakes me when the BG gets below the level I set for it.  The weirdest thing is that it doesn't take much in the night to correct the problem.  He BG falls slowly over several hours until it dips out of range.  I give 4-8 grams of carbs and he bumps back up to 150 then starts falling slowly again until he wakes in the morning.  Thankfully we have the dexcom to wake me up and he is able to crunch up a glucose tab without much memory of being awakened at all.  

I'm tired though!  I'm no spring chicken and waking in the middle of the night is hard on me.  I remember when my kids were under 5 and there was so much nighttime waking going on...how did I do that and still work?  I guess age is a factor.  TIRED.