The hardest thing I have to control is hormone peaks. I have made progress in the last year, but I am not yet able to deal with them well. Just better than I used to.
I get morning hormone peaks at school almost every day, starting right after school start, and lasting almost all of school. Most non-school days I don’t get peaks at the same time of the day. I also get hormone peaks at other times and other days, although many fewer.
When I started having these peaks, It took me progressively more insulin to take them down. By the end of last year, I sometimes needed more than 20U (one time 30U) to bring them down. It is stressful to have to use so much insulin (I typically use 40 units per day right now), because if you make a mistake you can run out of sugar, or you can run too low. And you have to inject all the time and keep right on top of your peaks when they go down, or it is really dangerous.
What I learned so far:
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these morning peaks are not due to breakfast, If I dont have any carbs, or low carbs (6-13), I still have them. They are little different from the ones I get if I get a high carb breakfast. And I don’t get peaks most non-school days even after the same breakfast, or after large breakfasts.
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I need a lot less insulin to bring these peaks down if I can exercise very regularly. I used to swim a lot, but it was not every say, and the schedule was irregular. In the end, that did not help me that much. Now, I run almost every day (I try to run every day), about 45 minutes or more. My runs are quite regular, and I never miss running more than one day on a row (like if it is raining badly for instance). Even though I expend less energy, I have now become much more responsive to insulin. I need less basal, but, mostly, I respond to a lot less insulin.
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I am able to bring my peaks down faster and with less insulin by using very high temp basals: +30 to +40%. Unfortunately, it is also causing deeper and worse lows.
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The cause of the peaks is not lack of exercise, or breakfast, but I think it is linked to lack of sleep. When I take a 90 minute nap every day, my peaks decrease a lot and become much more manageable. But I don’t have time to take naps every day or even often, with running, managing my BG, homework, etc.
Unfortunately, I am still not in control of these peaks. Now I can bring them down fast in general, but I get very deep and bad lows, when I have to use 100 grams of carbs or more, and they last hours: that is because I am now more responsive to insulin, and because I use large temp basals. Of course, I stop my temp basals as soon as I start going down for good. Instead I suspend insulin as I go down.
So I am now working on using a lot less insulin to bring them down, and still take them down quickly, so as to have less deep lows. I am not successful yet. It is a balancing act, and I don’t have it. Now I have both bad highs and bad lows—but I use a lot less insulin, and, if I want to, I can take them down fast (but I don’t want to if it costs me really bad lows).
One problem is that it takes a lot of time to have to manage these highs and these lows all the time. I am in a high more or less from 8:00am to 1:00pm, then I am in a low from 2:00pm to 6:00pm (not really a low all the time, but having to take carbs to stop from going low). It takes my focus away from all the other things I need to do. It often stops me from running when I want to, and from eating when I need to (because I am often too high at lunch time). So it is something I need to solve. But it is a lot better than it was in some ways: I have made a lot of progress. But not enough yet.
I think that some of what I have found is applicable to many others:
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Exercise increases your insulin efficiency, but does not suppress your peaks
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stress and lack of sleep may cause peaks
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it is not always breakfast that causes morning peaks for teenagers
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temp basals are powerful but difficult to use to manage peaks
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lows are as difficult to manage as highs when you deal with big hormone peaks