It took us just short of a year, but we finally discovered the right time of day to change Charlie's infusion set.

From the start of our pump training, we were instructed to change his site in the mornings. Before bed was not recommended for fear of low blood sugars.

So, we did as told.

And for months, Charlie's blood sugars were extremely high for a good part of the morning and into the early afternoon on site change days.

Our doctors weren't sure what to make of it. We all theorized that it was the stress of the site change sending him out of the stratosphere. Seemed to be a good enough explanation. He did absolutely flip out with site changes. The hope was that he would eventually not stress so much with the site changes and the blood sugar levels would fall into place.

Never happened and never happened.

At this point we were doing the change after breakfast. We started to wonder if it really was the stress that was bringing him up. Could it be absorption? A combination of stress and absorption?

Still months later, we revisited the site change day dilemma with Gary Scheiner, author of Think Like a Pancreas. Gary, who didn't look anything like a pancreas despite his ability to think like one, seemed to have the answer we've been so desperately looking for.

Timing and absorption. Of course! How could we have been so blind. It made perfect sense. Change the site before breakfast rather than after. Gary illustrated on a piece of paper how the post breakfast insulin from the new site would take a long time to make it through Charlie's subcutaneous tissue. This, of course, resulted in high blood sugars. A site change timed just prior to a large meal bolus would surely get that stream of insulin flowing.

Or not.

We then spent the next few months setting a temporary basal increase for the mornings of site changes. This helped occasionally but it didn't feel like a solution. Our pump educator offered a suggestion in the way we primed the pump. Yet another theory that failed.

Just for the hell of it, we recently gave nighttime a try. Just before Charlie went to bed. Guess what? We don't have site change highs anymore. So odd this disease. A disease in which so often the parent of the patient or the patient himself finds the answer before the doctor does. Diabetes is very unique in that way.

So often a work in progress. So often trial and error. So often uncertainty.