Daily Digest

• The improving TIR trend hit a wall. The trajectory from Wednesday (45%) through Sunday's stellar 89% was encouraging, but Monday (74%) and now Tuesday (53%) show a clear two-day slide. The weekly average of 64% TIR and 167 mg/dL average glucose tell us the highs are winning more often than not.
• Zero lows all week — still the safety anchor. 720 high readings vs. 0 lows across 7 days. The family is firmly erring on the side of high rather than low, which is an appropriate instinct for a child, but there's substantial room to reduce time above 180 without introducing hypoglycemia risk.
• Tuesday's insulin profile is revealing. Total daily dose was 14.5u (8.1u bolus + 6.4u basal), which is close to the week's average. But 202g of carbs covered by 8.1u of bolus means the effective carb ratio was roughly 1u:25g. Compare to Sunday's winning formula: 192g carbs, 10.25u bolus (~1u:19g), 89% TIR. That difference in bolus intensity maps directly to outcome.
• Correction frequency is escalating. Tuesday had 19 boluses — the most of any day — but many were tiny (0.2u, 0.25u, 0.15u). These micro-corrections suggest the AID system is nibbling at highs rather than making meaningful dents. The 32 corrections over the week (averaging ~4.5/day) confirm the pattern: chasing rather than preventing.
• Monday's low basal stands out. Only 2.85u basal on Monday vs. 5.8–6.85u every other day. If a site change, pump suspension, or activity change caused that, it may have contributed to the late Monday / early Tuesday glucose trajectory.

• Overnight (12am–7am) — actually quite good, with a classic drift pattern. Glucose hovered 148–183 from midnight to 3:30am — just brushing above range but never spiking. A slow, steady descent started around 4am: 177 → 171 → 150 → 132 → 122 by 6:31am. This gentle overnight drift into the 120s–130s is excellent. No dawn phenomenon spike. By 7am, glucose was 144 and gently rising — a beautiful launchpad for breakfast.

• Breakfast (7:15am, 2.4u for 45g) — aggressive initial drop, then overswing. Starting at 151, the bolus hit fast and hard: 151 → 125 → 111 → 92 → 77 by 7:51am — a 74-point drop in just 35 minutes. The family appropriately treated with 8g at 8:09am when glucose hit 71. This recovered nicely to 90 by 8:36am, but then the post-breakfast carb absorption kicked in: glucose rocketed from 99 → 150 → 181 → 209 by 9:56am. The low treatment + delayed carb absorption created a rollercoaster. A tiny 0.2u correction at 8:47am (when glucose was only 111) suggests the AID system, not a great time for a correction with carbs still absorbing.

• The most clinically interesting event: the lunch crash-to-spike sequence (12:22pm–2:11pm). Starting at 168, the 1.35u for 32g lunch bolus dropped glucose precipitously: 178 → 144 → 112 → 89 → 72 in under 40 minutes (double-down arrows at 12:52pm). This is strikingly similar to breakfast — insulin hitting before carbs absorb. The rebound was dramatic: 72 → 98 → 151 → 197 → 233 → 247 by 1:46pm. No low treatment was logged, so this 175-point swing from 72 to 247 was purely carb absorption catching up. Then at 1:56pm, a 0.4u bolus with 12g carbs was given while glucose was already 235 and rising — adding fuel to the fire. Glucose peaked at 297 at 2:11pm.

• Afternoon (2pm–6pm) — sustained highs with insufficient correction. After the 297 peak, glucose only gradually descended: 237 → 209 → 175 by 5:26pm. The 0.25u + 5g snack at 3:18pm while at 210 didn't help — glucose rebounded to 243 by 3:56pm. The 4:28pm bolus (1.15u + 30g) and 4:39pm bolus (0.8u + 20g) added 50g of carbs within 11 minutes while above 235. This is the grazing pattern flagged in Monday's analysis, now repeating.

• Dinner and evening (6pm–midnight) — the day's worst stretch. After briefly touching 168 at 5:36pm, glucose climbed again: 218 → 237 → 259 by 6:21pm. Corrections at 6:07pm (0.6u) and 6:23pm (1u) created a dramatic drop: 259 → 168 → 123 in 25 minutes (double-down arrows). Then three rapid dinner boluses — 0.8u+20g (6:53pm), 0.4u+10g (7:07pm), 0.2u+15g (7:22pm) — totaling 1.4u for 45g while glucose was recovering from the drop. The result: 131 → 153 → 180 → 220 → 254 → 282 → 308 → 329 at 8:41pm. The small corrections (0.4u at 7:52pm, 0.25u at 8:28pm, 0.25u at 8:45pm) were individually too small to fight a 200-point surge. Glucose finally settled around 210–215 by 10:30pm and was still 191 at midnight.

The breakfast and lunch boluses both caused rapid drops to the low 70s within 30–40 minutes, followed by massive rebounds — a pattern suggesting insulin is arriving before carbs. At breakfast, glucose fell from 151 to 77 in 35 minutes; at lunch, from 178 to 72 in 38 minutes. Both times, the carbs absorbed later and caused 100+ point spikes. This could mean the bolus is being given too far ahead of eating, the meal composition is slow-absorbing (high fat/protein), or the carb ratio is actually close to correct but the timing mismatch between insulin and carb absorption is creating artificial lows followed by overshoot. If the child is bolusing and then eating 10–15 minutes later, this data suggests they might benefit from bolusing closer to the first bite — or even slightly after — to better align insulin action with carb absorption and avoid the crash-then-spike cycle.

That 8g low treatment at 8:09am — precise, measured, not a panicked juice box — shows a family that knows the Rule of 15 and trusts the process even when watching their child drop to 71 with a falling arrow. That discipline is genuinely hard, and you nailed it again.