Need Opinions! My T1 is having high blood sugars

I need some opinions on what you would do.....
My son which is on a pump is eating breakfast at 8:15am getting his bolus 15 minutes before he eats, then goes to school and has snack at 11. The school nurse calls me everyday to tell me he is over 300. Do you think his basal rate needs to be changed or his insulin to carb ratio for his breakfast?
I have been in touch with the doctors and I feel nothing is working.....

Can you provide some additional information -

Does your son pump or take injections?
What is his blood sugar when he wakes up in the morning?
How soon after breakfast and after the snack is he hitting 300+?
Does he have the same problem after dinner?

he uses a pump. today he woke up 189. well he eats at 8:15 and when the test him at snack time at school 11am he is 323(today).
YES! why do you ask that??
Im new to pumping so all tips are greatly appreciated:-)

If you're new to pumping I would strongly recommend reading "Pumping Insulin" by John Walsh which has everything you wanted to know about pumping but didn't know to ask.

If 189 is higher than your son's target fasting blood sugar and more than 30 points higher than his bed time blood sugar then you probably need to increase his basal a little bit at a time until he is waking up within the range his endo suggests. You might consider testing his blood sugar in the middle of the night if you aren't already doing so.

The usual approach to working with a pump is to get the basals set and only then begin to work on the insulin to carb ratio. It simplifies and rationalizes the process. Once the basal is holding your son in the range that your endo suggests, then you can experiment with the insulin to carb ratio to cut down on spikes.

I asked about dinner to see whether the highs were limited to the morning or were an all day problem.

What does your endo say? Personally, I would increase the I:C ratio at breakfast.

What is he eating?
I don't use a pump but I know from sad experience that some foods do whacky blood sugar things at odd times.

I blame post eating highs on bolus ratio, rather than basal rate. I look to before meal #s for basal adjustments. I've noticed with a pump that even very small adjustments to either can make a pretty significant difference. If something I don't want happens for a few days in a row, I'll start experimenting and making changes?

I think one thing to take into consideration 189 is kinda high to start with. I know there is all sorts of different "thoughts" on children and diabetes and blood sugar ranges, but your son is CLOSE to the 200 mark even before eating. Depending on what he's it high in carbs? Things like pancakes/waffles/cereal/fruit...he could very easily be spiking to 300. I think basal rates could be off, and maybe I:C ratio's...but I'd like to first know what his diet consists of.

Have you tried other cereals to see if he is going as high with them? I have found that certain cereals raise my bs way too much, even though I weigh my food on a gram scale and bolus according to the carb count on the box.

Have you tried eggs and toast to see what effect that has on the bs? Carb with protein may not spike so bad.

I agree with a previous poster. Pumping INsulin by John Walsh is an excellent book. There is a fairly new edition out there that has more info than the previous edition.

HOw long has your son been on the pump?

I used to have super high after breakfast/lunch numbers too. Like jwinc it doesn't seem to matter which cereals I eat, they all make my blood sugar go to the stratosphere. I also found that I can't handle milk very well either, so I usually leave that alone too. I had gone to dieticians and such, but it wasn't until I started tracking it that I noticed the trend.

Also, do you do corrections? If you start out at 189, you want to either correct right away, or if he eats soon, add your correction into the breakfast bolus.

I think still_young_at_heart hit the nail on the head. You can rule out breakfast if the same issue is happening at dinner. It would seem more like a basal issue in that case.

Just to add:

  1. ensure basal rates are good
    a. watch for dawn phenomena (the morning post wake up BG spike)
    b. Ensure you are doing corrections for those high BGs as Zoe mentioned
    b1. those corrections might take some trial and error to figure out (e.g. 45mg/dl to 1u insulin)
  2. test before and after meals to adjust the I:C ratios
    a. try to have your son eat the same meal for a few days in a row for testing purposes.

Good luck.

Take a close look at his diet and insulin.

I would also suggest leaving insulin and syringes with the school nurse, along with instructions on how to use them. Sometimes pumps fail or infusion sites act up. It is good to have a plan B.

Be patient. It's not easy. Just keep working on it. You'll get things straightened out.

Have you considered a cgms (continuous glucose monitoring system) trial? Some endos will do a 3-5 day trial. My endo has the cgms that doesn't have any digital readout of the bs. YOu wear the sensor and you have to input when you eat, carbs, insulin, etc......then the info gets downloaded to see what is going on throughout the night and day. Cgms measures interstitial fluid every 5 minutes and supposedly has a 10 minute lag time compared to actual bs. It isn't always accurate, but you can see rends quite well.

For me, sometimes I am still high after 3 hours (in the 200's) but will be back down by the time 4 hours comes around. Is you son going low after you are doing corrections and having that snack with some active insulin still on board?