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Re: [IP] Bg rise in a.m....

     Melissa's breakfast ratio is 1:7, lunch is 1:8, dinner WAS 1:10..but
she's been running high at bedtime, so her CDE wants that dropped down to
1:8....There is TREMENDOUS variation in carb ratios among pumpers I've
learned. As has often been stated here, the beauty of the pump, unlike MDI, is
that if it's NOT working, there are always other permutations to
consider....Melissa's A1C pre-pump was 8.8 and went down into the mid-6s for
over a year, BUT the one in March was 8.9 and the one in June was 8.7....Her
endo (not a ped. endo) simply said "this ain't workin' kiddo..so what are you
going to do next??"....No recriminations, just a realistic OK, time for a new
game plan....We "brainstormed" plausible explanations & came up with several :
     a. 6 months worth of "slacker" sports commitments= basically zero
     b. emotional stress factors (mom's diagnosis)
     c. finishing her growth spurt &coming OUT of puberty= different hormonal 
    d. sloppy carb counting ("but MOM - dividing by 10 is sooooo easy!!)
    e. basal rates probably wrong.... hard to know though when one keeps
procrastinating on doing a basal fast test! LOL
    f.  lack of record-keeping makes it soooo easy to ignore "trends"...the
fact that the CDE can download the info from the meter is no excuse for
ignoring daily record-keeping
        So, "facing" up to all the elements that could be improved & actually
taking some action HAS in fact made a big difference. She's already done the
overnight fast & BOY did those basals need changing & today she's doing the
daytime one. Her CDE changed her bolus ratios & that HAS helped.....And I
decided that if record-keeping was an "issue" for her, then I would take
over...I keep a stenographer's tablet in the kitchen & just jot down the bgs
each evening...It's simple & it works & the "side bonus" is that actually
seeing the improved bgs becomes its own motivator to keep the pattern
     So to wrap this l-o-n-g reply up, if it's NOT working , "brainstorm" the
elements that could be adjusted.....

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