I was diagnosed early. I barely needed any insulin in my first year, and A1C was normal. I was at or below 6 for my first year, I think. Gradually it went up to about 7 and stayed there for 20 years. When I switched to a pump, it went down to about 6.3-6.5. Over that time, I’ve switched insulin brands and types multiple times, gone from taking about 10 units a day to nearly 100, and had to make educated guesses about all sorts of things.
But it varies a lot. Depends on the particular patient. How much of their insulin production capacity was left when they were diagnosed? How quickly are the remainder of their beta islet cells being destroyed? How well are they taking care of themselves? How much do they exercise? What do they eat? What other medical conditions do they have? Are they taking any medications that could affect BG or insulin sensitivity? Are they going through puberty and/or growth spurts?
T1D is a highly individual condition, with so many contributing factors to BG control. And the honeymoon period is particularly unpredictable.
It’s not about what’s “typical.” You won’t find an average patient any more than you’ll find a family with 2.5 kids. Managing T1D is about taking it as it comes. Where is the patient right now? What’s going on in the patient’s life? How can we make things better for the patient without constraining them with unrealistic and stressful constraints? How do we balance the patient’s individual needs? What carb ratio works best for this patient? A lot of it is trial and error, and it needs to be adjusted on an ongoing basis.
Don’t worry about what’s typical.
As for BG levels after eating: Taking insulin before the meal so it can have time to absorb and start to work can help. Match the curve of insulin activity to the curve of food digestion. Watch what you eat and plan for it. Adjust dosage and carb ratio. Get a feel for what works without risking lows.
I used to have a glass of milk with breakfast every morning. I took insulin to cover. My lunchtime BGs were always fine. But when I got a CGM I noticed that the milk was spiking my BGs for a couple of hours mid-morning. The lactose kicked in and then faded away by lunchtime, and we hadn’t accounted for that. So I switched to sugar-free drinks and my levels evened out. Of course, if not for my sleeping disorders, I might be more active in the mornings, and then that sugar would be burned off and might even be beneficial.
(This is why switching from exchanges to carb counting always irritated me. Carb counting oversimplifies everything. Simple sugars, complex carbs, fats, proteins… They all digest differently and have different uses and nutritional values. In my head, I still try to stick to exchanges even though my pump only understands estimated grams of carbs. Having the flexibility for snacks, special occasions, etc. is nice. But overall a healthy balanced varied steady diet is important for BG control and meeting nutritional needs. As with most things, it’s a matter of finding a good working balance: In this case, the flexibility to live day-to-day life, adapt to what’s going on, and not feel overly constrained to a stressful and repressive degree vs the need to have good BG control and a healthy diet. See where you can get those to align, and then find a workable balance between conflicting needs so that they’re all being met to a reasonable degree. And then adjust as necessary when circumstances change.)
Good luck with your new patient. You’ll both get the hang of things with experience. But it’s good of you to reach out, use available resources, and learn from patient experience. Some doctors just go by the book and dismiss patient knowledge, particularly if it comes from online spaces, and in doing so, they do themselves and their patients and unfair and unnecessary disservice. Thank you for keeping an open mind and acknowledging your limits and gaps. That’s a great start.
Remember, you can direct your patient to us, as well, if they need additional support and advice.