About six weeks ago I posted about my 14 year old daughter's horrible A1C (8.6) and got an out-pouring of comments. All were very appreciated. Over the past six weeks we've made a few adjustments, but we are still having difficulties. Here's what we've done: 1. I know it sounds weird, but we've taken break from CGM. We found that she was overreacting to the information (going down or up with two arrows). She would end up yoyo'ing all day as a result. We will go back to it when she is more stable. 2. Pre-bolusing well in advance of meals. Sofie eats, for the most part, a carefully constructed, low glycemic index diet. For example, sprouted grain toast (10 g), almond butter, and 4 oz of milk for breakfast. She has to bolus for this at least 1/2 before she eats or she spikes very high. If she gets the bolus in on time -- things are good. 3. Not removing the pump for workouts. Temping up for some workouts and down for others (sometimes it's hard to predict -- it's not as straightforward as aerobic and anaerobic). 4. Lots and lots and lots of insulin. And I mean TONS of insulin. I just want to say that she is a bright and committed person who is very concerned about keeping herself healthy. She is also extremely sensitive to hormone surges, insulin and carbs. I realize that all teens are, but my endo seems to think that she is particularly sensitive and always has been. Even at diabetes camp she would come home every summer with letters from the doctors saying how they had such a difficult time controlling her BGs. For example, this morning she woke up with a BG of 6.5 (sorry folks, I'm Canadian). She had a day off school so she had slept in -- it never makes any difference to her BG -- as I said -- nights are nailed. Instead of bolusing 1/2 before she ate, she bolused 10 minutes before and instead of the sprouted grain toast she had an apple. The result? A spike to 17 an hour later -- and this is on a 1:4 carb ratio and weighing the apple and using bolus wizard. This is what we're up against. I regard myself as a pretty intelligent person, university educated and a professional. My daughter is gifted academically and maintains an average in the 90s. We get it -- what we don't get is the unpredictability of it. I appreciate all of your stories of success, but sometimes they can be a little bit condescending. We're really struggling here. We need help and thanks to those who have provided it.