I'm just about to start my 3rd year of university. About a year ago I was in a situation where I didn't know how to fix my diabetes, especially overnight. I would lack energy during the day because high blood sugar would disrupt my sleep. I'd also feel angry with myself, because I'd have bad control despite being fortunate enough to be on a pump.
One of my main problems was that when I'd have a high sugar level, I wouldn't know whether the basal or bolus setting was the cause. I realised that my pump was mainly being used to fix problems created by it's own settings. For example, at 11pm: my sugar level was being affected by the carbs in my dinner, the bolus for that dinner and the basal rate. I would feel uncertain about which dose to increase. Sometimes I'd make a change, wake up low in the night and get very scared as a result. Most of the time, I'd go to sleep, my sugar levels would rise and at 8am in the morning I'd be high and unable to explain the cause. I was told the pump was better than injections for fine-tuning control, but this wasn't of much use at this point.
I got myself referred to a different diabetes centre. This was a bit further away, but I found the change was worth it. The doctors and nurses there told me that I had not had enough training on how to use my pump. I was also given a glucose/food diary printout. I was told to avoid eating carbs for a day so they could see the effects of my basal insulin only. I was told to worry about my bolus settings only after I knew my basal rate was ok. This was the first fix to the problem.
Even with my basal rate adjusted, I still went to bed not trusting that my sugar level was stable. Sometimes I'd dose too much for dinner, sometimes too little, despite carb counting. This would cause a lot of unpredictability overnight and made me question if my basal rate was broken again. I decided to eat dinner earlier, between 5 and 7pm. This was a difficult change to make, because I was used to eating between later, whenever I wanted. My diabetes team said this shouldn't be necessary, but I decided to do it anyway. This was fix number 2: I could go to bed knowing that I'd had an opportunity to correct any highs/lows caused by the bolus for dinner. The testing before bed gave me the information I needed to change my bolus insulin only.
Finally, I began to treat my diabetes more as if it was a moving target. This required more testing and a more structured "long-term" approach to adjusting my doses. I'd try and do one of these basal rate checks every 6 weeks. I found this difficult, so I only checked 6 hours of each day without eating / extra physical activity / caffeine at a time.
It helped that my diabetes centre got a continuous glucose monitor (CGM) to share between the patients. I was able to get this on loan for up to 5 days, and a nurse would analyse the results and tell me where my basal and bolus rates were not working. I found the CGM to be very helpful because it made problems with my control much clearer and easier to fix. Unlike a pump, one CGM can be shared between a lot of patients (lowering the cost). In my opinion, they're at least as powerful a tool for improving control, even if only used occasionally. This is because one CGM session can give information needed to make longer term fixes to basal and bolus rates (if you are on MDI or a pump).
This has comment has become very long. I was overwhelmed with the problem of diabetes control. I want to assure you that this big problem can be broken down into smaller solvable ones. For me this took some minor lifestyle changes so I could distinguish between problems caused by my basal and bolus doses. Better monitoring and a better diabetes team also helped.