My eight year old son, who has been on an insulin pump for about nine months, has maintained overall great control with A1cs of 5.7 and 6.7%. However, even though his after breakfast blood sugars are in target range most of the time, he has always run higher pre-lunch (200-300 mg/dl [11.1-16.7 mmol/L]) at school than at home on a fairly consistent basis. He doesn’t have any ketones. Our correction factor pre-lunch works well as he is in target range at his next blood sugar check. We increased his basal rate (8:00-1:00 am) for several days by 0.1 unit, but this did not affect the pre-lunch too much. How much can stress/excitement increase blood sugars? Could growth hormone be playing a part? Is there a successful way to combat that?

Stress/excitement might be causing high blood sugars. Have you double checked whether your son eats some extra food at school during the morning? I have had some children, either on pumps or intensified insulin regimens, with the blood sugar pre-lunch patterns strikingly different on weekdays when compared with the weekend and found that this was due to extra snacks given at school by their mates.

MS

[Editor’s comment: You might try using a combined or extended bolus at breakfast, especially If your son is receiving a high fat meal (e.g., whole milk, butter, bacon, etc.). You also could try adding another basal rate from breakfast to lunch that is higher than the one you tried before. Discuss with your son’s diabetes team, of course!

In any event, your son’s hemoglobin A1c values indicate excellent control, so I would not be too alarmed. It can be very frustrating to try to achieve “perfect blood sugars” 100% of the time, and you might throw things off to a greater extent.

SS]