Hi @Lburg86. Please forgive me if it sounds like I’m playing 20 questions but I do have a few to consider:
You said (I’m paraphrasing) that your son runs consistently high. Has his endo looked into adjusting his basal rates? I understand the instinct to bolus frequently since he runs high, but I had made some self adjustments (I’ve been pumping for about 20 years now) and my endo said my boluses were out of proportion to my basal rates, so we made some adjustments to the basals, which helped.
He eats every hour - is that even close to literal? I knew teenage boys like to eat, but that sounds excessive, if you mean it literally. I’m no doctor but I believe there are disorders that can affect a person’s ability to feel full, so they eat even though they shouldn’t be hungry. Perhaps your doctor could look into that.
He is a teen so this term won’t be appealing, but does he see a pediatric endo? They understand the hormonal and other considerations that impact teenagers which may not apply to older adults.
Does your son keep a log of what he eats (yes, the dreaded log!). There are some excellent diabetes apps that are easy to use - I use Mynetdiary and have found I do much better when I track with it, than when I do not.
Has he seen a dietitian? I’ve been diabetic for over 50 years and my endo refers me to one every now and then to tighten things up and get a refresher. There is something called the glycemic index: foods that fall at one end raise your blood sugar quickly but don’t stick with you; while those at the other end cause a gentle rise and keep you stable. There’s more to it than just the carbs, so it might be worth looking into.
Many years ago I participated in a food sensitivity
study. As I recall, the premise was that some people may react strongly to a particular food despite bolusing correctly for the carbs. That’s the best I can explain it - sorry - but it may be something to look into with a dietitian.
I use a pump and have found that if I’m running high, and even switch to injections to bring me down and they don’t work - it’s a sign that I have an infection. I’ve had the occasional UTI with no pain or discomfort whatsoever; and a mild toothache I ignored that ended up needing a root canal. In those cases, literally the only thing that suggested something more serious may be going on, was my blood sugars. As an aside, this might be something for his primary care doctor to handle. I suspected an infection one time and had an appointment with me endo the very next day, so I waited to ask him about it. He said he didn’t handle anything outside of endo and told me to see - you guessed it - my PCP. Check with your endo to see if s/he handles “other” issues before you waste time and money on a visit.
And finally (at last!) some people find they simply can’t use a particular type of insulin. Options with pumps are limited so hopefully that’s not the case of he wants to keep using one. I grew up when insulin was U40(!), derived from beef and pork, and one I believe was called protamine zinc. Yes, it’s been a while. One they started making insulin in a lab using recombinant DNA technology, some people said that only the old pork insulin worked for them - or the newer one worked but not as well. That’s drastic and highly unusual, and I’m not trying to make you panic. Just suggesting that there are a number of insulins available if he is willing to go back on MDI. Pumping may be considered “the” treatment now, but some people do just fine on shots, and actually prefer them. I knew you said your son started with shots and had the same results, but returning to them with a different insulin might be worth checking out.
Keep us posted on progress.