My two-year-old has had type 1 since the age of 11 months. A lot of the time, her sugars are over the place, which is why we are putting her on a pump in the next month or so. If she wakes up at 8.5 mmol/L [153 mg/dl], has only 20 to 25 grams of carbohydrates and I give her 2.5 units of NovoRapid and 5.5 units of NPH, she is not in range in two hours. But, at supper time, if she is 8 mmol/L [144 mg/dl] or 9 mmol/L [162 mg/dl] and she has 40 to 45 grams of carbohydrates and I give her 1.5 units of NovoRapid, she is in range in two hours. What is so different about the mornings?

I can think of a couple of possible explanations:

In the evening, if you give some extra rapid-acting insulin, there may still be some of the morning NPH residual still having a “tail” effect.

In addition, although a “rose-is-a-rose,” I do not think that a carbohydrate-is-a-carbohydrate.

The 45 grams of carbohydrates in some morning juice, milk, toast and cereal will not be digested and absorbed the same as the 45 grams of carbohydrates in the baked potato, rice pilaf, or other starchy foods. Furthermore, the fat content in a meal will affect digestion (typically slows it down).

I presume that you will get to have more interaction with a registered dietician as you begin your pump journey.

DS