1) Do you pre-bolus? If so, how many minutes before the meal and have done after-meal testing to see if the pre-bolus has eliminated or acceptably reduced the post-meal spike? We just started pre-bolusing yesterday, that was one piece of the puzzle we did get yesterday that we were missing. 2) How many times a day do you test BG to make sure the CGM is properly calibrated? We calibrate every time we do a BG (if it's in the ok range to calibrate) so, 6-10 x/day. 3) What is the target BG range you are aiming for? Officially we are aiming for 80-180 according to the endo When we have a "good week" that we feel she is doing well, we are around 80-140. I am pretty happy with that range, but it is very rare for us. The pump is correcting to 110+/- 20 from 10pm-6AM, and 90 +/- 20 from 6 AM-10PM. 4) Do you eat high, medium or low glycemic index foods? Have you made changes to diet to temporarily reduce or eliminate foods that repeatedly cause stubborn highs or bad spikes? Her diet varies greatly. Sometimes mostly protein, other times a higher glucemic index. We don't see much of a consistent pattern, except for Mac and Cheese and Thick-crust pizzas bring her higher, which we have learned to minimize almost completely with the combo bolus. 5) Do you count carbs, and bolus according to carb ratios that you are confident are working for her? We do. We have attempted changing a few of them lately with some really low lows as a result (30's and 40's every day). They seem to be right. The endo agrees, doesn't mean they can't be changed. 6) Do you correct when her BG is high, and if so what correction factor are you using and how was it derived? How many times a day will you correct if she is running high? If she is running high we always check her IOB, we use one of two correction factors, 12am-5pm it is 1u:100, from 5pm-12am it is 1u: 90. If she doesn't seem to have too much IOB, we will correct as many times as we need to, sometimes 6-7 x/day, sometimes she only needs the 3. 7) What % of her daily insulin needs are covered by boluses, and how much by her basals? We are almost at at 50% each. The day I am reporting on here is not so even due to the high #'s at bolus 17.7u and basal 11.16u. Most days we are within .5 units of being equal. 8) Does your daughter exercise every day? Would you describe her as active or sedentary? She is pretty active. Swims 1-2 x/week, pretty strenuous gym class 2x/week, plays outside 30-200 minutes daily depending on her desire . . 9) How much does your daughter weigh, and what is her TDD? She is around 75#. Her TDD on the day I am covering waas 28.86u. 10) Who makes the insulin dosing decisions - your DD, you, or the clinic? We have been. It was set up by her old endo and they tweaked it for us for a while. We didn't like waiting for a response. A 250 BG today is the 500 BG of tomorrow. 11) Do you log her stats? Yes. 12) After you've posted answers to these questions, try in a second post to give us a day's worth of numbers (time and amount of every bolus, basal rates, all carbs consumed, and BG readings for: - before each meal; 7am -- 86 , 5.45u, 10am snack 0.80u, then 2nd snack of 0.9u (birthday treat in class, ugh), 12 pm 114 3.45u, 3:40 pm snack 0.9u followed by 45 minutes of swimming, 6pm--234 4.8u. 2 snacks 7:41 0.50u and 8:27 0.90u. - 2 hours after each meal -- 9am 240; 2pm 180, 8pm-200 -- her bedtime (9pm) 239; - your bedtime 10pm 229; - 2 overnight by 12:30 am she has risen from the 229 to 400 which we bolus for coming back down below 180 by 4 AM, when she wakes the next am she is 88. I do not have her exact carb info for everything, but her meals were breakfast: 70, lunch 69, dinner 78. It sounds like a lot of work to answer these questions and it will be a lot of work. But I think it will be worth it. The folks on this site have more experience between them in managing the D than the all of the staff at your clinic.. I agree, you guys are much more experienced and I SO appreciate all of the advice. Thank you so much for any insight you can give us. Let me know if we missed anything.