My daughter's been in great control for the past month, staying between 70 - 140 more than 90% of BG checks. Yesterday was quite the exception. She is taking a series of standardized tests at school, and I asked her to test her sugar after every test. These were her sugars between 7:30 (at breakfast) and 3:30 (when she got home): 113, 250,150, 59, 103, 79, 115, 58. She also dropped 13 points at betime in 16 minutes.

 

Inititally, I thought the problem was breakfast: Stupid me, I fed the kid all carbs and no protein, but they didn't level out after a balanced lunch or a good dinner (no more than 45 carbs per meal).

 

So, it's a new day. She was 115 before she left for school, and she had a very typical breakfast mixing carbs (25) and protein. She just called after her first test: 256. I realized (probably because I was on Tu at the time) that the "rules" of testing say to evaluate the BG 2 hours after eating; it's probably only been 1.5 hours, and I told her not to correct but to call again after the next test. But now that I'm typing this, that explanation really doesn't make sense either. Even if she overcorrected when she was at 250 yesterday, why did it continue to be erratic all day long?

 

Tu friends who are smarter than me: what the heck?

 

 

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Stress with testing.
I would say stress too...however a whole bunch of things can make your sugars go wonky. She is probably a normal kid, that is growing (sugars play havoc there) and possibly at that age of puberty? Maybe she didn't sleep right the night before or might be fighting a cold/infection.

Every day is a new day. I truly wish it could be perfect and routine every day with our sugars, but life is ever changing. Our bodies change too. Keep doing what you're doing by monitoring and making small adjustments.

I hope they balance out soon and wish her luck on her tests :)
Maybe it's also stressing her out to test her BGs after every test.
what time does she bolus for breakfast in relation to eating the meal? for most of us (NOT all) the morning is a hard time to achieve ideal BG #s due to the dawn phenomenon. for instance, i know that my insulin is most effective for ME when injected 30-45 minutes prior to eating (as long as BG is above 100) in the morning (15-20 mins for other meals). This may be extreme for her, but maybe increasing the time between her bolus and her meal even 10 minutes would allow the insulin to become more distributed in the body. remember that we are injecting (or pumping) into fat, not directly into the bloodstream where the pancreas would dump it. and we as diabetics never want our BGs at 250... whether we test 2 hrs or 1 hr after eating. yes it does happen but it's good to know now that she is spiking after eating. ratio adjustment maybe? (and i know that this can be scary when she's at school and not at home. i love summertime for insulin testing)
I hate to jump on the stress train, but I have to agree. I am one of those people who HATES attributing erratic BGs to stress because I don't like to think that they're erratic on their own -- I like to find reasons that have something to do with how I'm treating myself. That being said, I've only had T1 for just over a year and EVERY SINGLE TIME WITHOUT FAIL that I have taken an exam my BG has been high then low, high then low. This started to annoy me so on the next exam day I ate NO CARBS at all before the test (which was at 2pm) and I STILL got high before the test! My CDE confirmed this does happen to a lot of people. (I even said, "I didn't feel stressed, I was super prepared!" -- but I guess our bodies can sometimes get stressed even if our minds aren't as nervous!)
It is just the stress from taking the tests.. Once she is done with the standardized testing it should level out again..

My blood sugar sky rockets when I am in a really stressful situation.. And it takes a long time and lots of insulin to get it back down..

Stupid state testing!
I think it can take a lot longer than one wants/expects for things to return to normal ...like for me personally, if I start out really low (50s or lower) the rest of my day seems to be erratic due in part with dealing the effects that the prolonged low had on the rest of my body. Another reason is how close was the post-breakfast correction to the lunch bolus?
Not scientific at all but I've noticed that often when I inject/bolus twice within an hour or so of each other the effect turns how to be stronger than if I had either done it as one bolus or two separate ones spaced much more....
It looks like it was overcorrected for the first low (250-150-59) and the next three seem pretty normal...but not enough detail to really say...
as for the second low...maybe the effect overcorrecting, then normal lunch bolus, lunch which would put it in the normal range,....but then dropping down again once all the food was digested but with extra insulin on board-...Could be the opposite result of stress~ for me when I experienced good stress (esp. if it involvded any kind of physical activity) I tended to drop really low.
I forget why and what the exact circumstances are...but my understanding is that one hypo increases the chances of having a recurring episode. I think part of it is a temporarily blunted hormone reaction...
Hope she did well on her tests though!
The lows I'd put down to a whole lot of brain activity - don't forget, the brain relies on glucose for fuel, so if she's taking a test, there's a surge in the need for glucose in the brain, and unlike the rest of the body, the brain doesn't need insulin to grab hold of glucose! It's as though instead of doing the test, she's jogging... just as exercise lowers blood sugar, intense concentration does too. So you may want to have her back off the insulin at test time, just a smidge.
Thanks everyone for your input. She took tests every morning all week, and her sugars stayed irregular. We tested her BG mire frequently on Sat to see if ratios were off, and she seems to have calmed back down, so to speak. I have to say, I was surprised testing could do this to her, as she wasn't worried about it, was well-prepared, and it isn't for a grade. Even if it wasn't actually stress, the brain uses a lot of energy... All's well that ends well, at least until the end of next school year.
Children have high postprandials as a rule. You can either prebolus by 15 minutes, overbolus if you are home and can adjust at the two hour mark (most likely will be feeding some of the insulin). Goal I was told possible was 200 at the one hour mark, 160 at the 2 hour mark. Meeting this goal, she will drop in the third hour, so at school I accept the 180 to 200 at the two hour mark. Your child may be different and you might be able to achieve tighter control. Oh, and careful about the carbs at breakfast. We never go over 40, usually under and never cereal or other foods that will spike BS.

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