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Ginger Vieira says

Okay, well first of all, it is not uncommon to need more than just one
 insulin-to-carbohydrate ratio (ICR). Many people are more insulin resistant  in the morning, so they need an ICR like 1:8 or 1:6. Meanwhile, some people are more insulin sensitive in the second half of the day because they've been running around all day, working, at school, etc.. So you can adjust your ICR to 1:12 or 1:15. It's all about noticing when you're clearly getting too much insulin (through low blood sugars) and not enough insulin (through high bloods sugars). Keep track of the day and time and try to determine the patterns. They're are always patterns, and somewhere in there is a clear reason why her blood sugar is fluctuating so much.

Secondly, yes, foods like pizza and other junk that is high in both carbohydrates and fats tend to require more insulin because the fat slows
down the absorption rate of the carbohydrates. My advice to counteract this (without an insulin pump) is to give a little extra insulin for every 15
grams of fat. For example, I give myself about .5 units more insulin for any meal high in fat. For every 15 grams of fat, I give .5 units more insulin in addition to the insulin I gave for the carbohydrates. Be persistent, Marie! There are answers to her blood sugar fluctuations, it's just about building your knowledge so you can understand them.
 -Ginger

(p.s. I'm publishing a book this January that covers a lot of this in even
more depth....stay tuned!)

Gary Scheiner says

There are many important questions and issues in your message below.  To answer them properly would take up an entire book.  So let me give you the "reader's digest" version.
 
 1. If your child is a picky eater, don't make every meal a family catastrophe.  If she won't eat something that you gave insulin for, you can always compensate with a beverage containing carbs, such as milk or juice.
 
 2. Using the same I:C ratio at each meal is probably not going to work.  Almost everyone requires different ratios at different meals.  If your health care team isn't aware of that (or helping you to adjust), maybe it's time to work with someone else.
 
 3.  Having stable blood sugar should NOT be a prerequisite for going on an insulin pump.  I don't know any kids whose blood sugars are as stable as you described.  The purpose of the pump is to GET the kind of stability and lifestyle flexibility you're looking for.  Again, if your health care team doesn't get that, might be best to look elsewhere.

4. Different foods do effect BG differently.  The carbs in some foods raise the BG very quickly; others take longer.  This is called "glycemic index".
 
 If you are interested in some personalized care for your daughter's diabetes, please give my office a call.  We work with families all over the country on issues like these.  Our CDEs provide consulting via phone and internet, and all of us live with type-1 personally.  My website has details:  www.integrateddiabetes.com.
 
Gary Scheiner MS, CDE
Owner & Clinical Director
Integrated Diabetes Services
333 E. Lancaster Ave., Suite 204
Wynnewood, PA 19096
toll free: 877-735-3648
(610) 642-6055
fax (610) 642-8046
 www.integrateddiabetes.com
> gary@integrateddiabetes.com

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