Are crazy sugars a given?

My daughter was dx in Dec., so I don’t have much experience yet. I hear growth spurts are hard to manage, and I’ve certainly read posts here from frustrated adults who are swinging crazily even though they seem to be doing everything right. My question is this: is there anyone out there who is able to maintain good control without roller coaster sugars? I sure hope so!

You can manage without the rollercoaster but most likely not all the time. There are always outside forces and various other things outside of your control that will affect your blood sugar. Very few if any type 1s maintain perfect control and those who get close are very diligent and most use important aids such as low carb diets, insulin pumps, and cgms. But even they will fluctuate some as that is the very nature of all t1s. Sorry I dont intend to sound like a neighsayer this is just my experience.

I’ve found that the insulin pump and CGM (but mostly the pump) helped me avoid those crazy ups and downs. When I was using the pens, I was just all over the place. The pump has really helped me get tight control. I still have some annoying lows and highs, but now my annoying highs are in the 190 range–much more manageable.

Part of this, is defining “crazy”.

Some here have such tight control - or maybe such easy-to-control-diabetes - that they regard any number above 120 as total failure.

I certainly do not fall into that category. On a really good day I will have most, or maybe even all, of my bg’s in a 70-to-120 target range. But that’s a really good day, not a typical day. On a typical day I will have after meal numbers definitely higher than that, and my before meal numbers can easily go out of whack (either high or low) too.

Being in control is not about having all your numbers be “good”. Being in control is, IMHO, having a process that handles the out of whack numbers that will occur and correcting them usefully. Usefully means “non-judgementally” at the emotional level. Those bg numbers aren’t there to tell you that you’re bad or good, or that your control is bad or good, they’re to help you be in control.

Maybe my perspective because I was diagnosed 30 years ago before home bg testing was readily available. I view home bg testing as such an important and essential tool. Not the goal, or a judge on my worth as a T1, but a tool.

I think your daughter will have to get actively involved in her care before her BGs are totally under control. Otherwise she will be rebelling against you, you will be the bad guy.

I don’t think it’s a given that one has to have the really dramatic roller coaster BGs (going from 40s to 300/400s), but it’s definitely more doable to have a much smaller swing with varying amounts of work ~ for me the CGM has been great for helping to reduce the swings because I can time the insulin better with meals and act faster.
I think it’s hard to reach a point where one can maintain tight control with minimal effort w/o drastically cutting down on variables (same meals, same habits from sleeping to exercise, same stress levels)…there’s just too many variables…e.g like getting sick, absorption differences (more likely if not on a pump), also low lows tend to create a boomerang effect for me (either overtreating, or if overnight, dumping out too much glucose the next morning) and hormones which can be double for most females (both growth and the fluctuation associated with the menstural cycle~which is something I had first heard about on this site and is my next goal to tackle (adjusting basal based on the time of the month)
I think the more knowledge one has about different tatics, but also one’s self (or the person they’re caring for) the better able one is at managing…but like life it’s not always smooth sailing :slight_smile:

I love your definition of control. As a kid, my family and I took for granted that 40 to 400 was the norm, even with effort. 20 years later, I feel I’ve learned to recognize what factors effect me and how to respond quickly to the unexpected. Control should be measured by a combination of attitude, effort, attention, effective implementation of your chosen tools, and standard deviation (as opposed to A1c alone). The norm for me now is more like 60-200, with an occasional outlier, but it has been a long road getting here.

I’ve tried to work smarter not harder. Well maybe a little harder.

The foundation of good control is an accurate basal rate. Basals can be seemingly all over the map. Mine were. But then somebody told me about basal testing – thanks again Dave! Now I have 24 basal rates and 16 basal changes in a day that range from .40u to 1.85u per hour. A real rollercoaster pattern!

It took work to find rates that kept me level without food, and I had additional challenges before lunch that forced me to drop thos rates slightly against my initial judgement. But once my rates were in place, the resst just sort of fell into place. It’s a huge variable in most of our regimens, but no longer in mine. I can sleep in till 3pm like I did on Sunday and wake up with more or less teh number I went to bed with. It’s not that accurate, but it’s close.

Children have the added problems that they are both growing and changing. I’ve read that basal patterns can change as we grow. I’d recommend spending some time basal testing, establishing a pattern, then upping the whole pattern bya percentage when the need is discovered. One approach is to re-test a segment once a year.or even once a quarter. Also understand that it’s not an easy exercise for kids. You have to skip meals. During school is out, but finding a pattern that works at home and school is tricky. …

My A1C is pretty stable at 5.9% and I have very few nasty hypos. I’ve had two this year. It’s been about one a month over the last three years. Zero 911’s though. I’ve had nine in my career.

Yes, there’s lots that can be done to minimize variability.

Agreed, particularly since using CGM I spend much less time 200+ A high for me any more is in the upper 100 range… I’ve gone entire days where I haven’t topped 150 (or gone under 60)… not that it happens all the time, but it DOES happen, and the fact that it does shows me it is possible… it’s what I aim for. I haven’t been over 300 in… I don’t even know how long now… probably 6 weeks :slight_smile:

I also agree with your definition of control.

“Control” is not about never having highs… it’s about what you do when you are high. Highs happen, that’s just the reality of having diabetes… I don’t personally believe that ALL highs can be avoided (because there are simply too many potential causes), the difference in control comes in how proactive you are in treating them.

I don’t necessarily consider myself more in “control” now that I wear a pump and CGM, I simply have better tools to get the job done.

I had a hell of a time keeping things on the level during adolescence. I’d go through periods of insulin resistance, then insulin sensitivity, back and forth again as growth spurts happened. Combine this with allergies, seasonal changes, etc. and it can make things very challenging.

As much as it is important for your daughter to take active control of her sugars, having parental support for the extremes can be a blessing. During the turbulent times in growth spurts, it’s harder to achieve a ‘baseline’ feeling to compare lows and highs to, so having a sounding board is incredibly valuable.

For me personally, it is important to achieve a balance between having to rearrange my entire life/schedule around maintaining rigid control, and having the freedom to actually enjoy my life/schedule and have the ability to improvise. In the long run, it’d be best to have the same day every day- same food, exercise, sleep, etc. but how boring would that be? If my parents had implemented a rigid schedule for me as a teen, I would 100% have rebelled against it- even with the knowledge that it was for ‘my own good’.

Everybody’s body is different, it takes a long time to figure out a way of adapting that works for you. Doctors, nutritionists, parents, friends, and other diabetics can provide a good place to start, but control comes over a long time of learning to listen to your body, learning what works and what doesn’t. There will be lows and highs, things will get difficult before they get better, but they will get better :slight_smile: