MDI Question

Why does she have the snack - because everyone else has one at that time, or because she's hungry, or was it to avoid hypos on her previous regime? Traditionally snacks were used with fixed regimes of long and short acting insulin injected twice daily. Ideally with MDI or basal bolus regimes the long-acting insulin keeps blood sugar even and the short-acting just deals with the food. If the long-acting dose is right, snacks should be unnecessary except perhaps before a PE session or any unexpected activity.

Depending on the reason for the snack, the answer may be to remove/reduce the snack or to increase the morning insulin to cover the snack as well.

She may need more insulin with dinner too, but best to change one thing at a time for clarity.

I would look at the snack first..

Ask yourself some questions

How many carbs does the snack contain?
What is the purpose of the snack (avoiding hypo's, because the other kids are having a snack)
Could the snack be brought forward if she needs one, say by an hour as a starting point?
If she having a snack because the other children are, is there any alternitive she could have that doesn't contain carbs or a lesser amount of carbs to lessen the impact on her blood glucose levels..

He lunch time ratio's I would leave at the moment, if she is 10 before lunch and similar BG after then it's likely that these ratio are correct... In general if there is only +/- of BG of 2-3mml/l then you petty well spot on...

Does your wife allow extra insulin to cover the snack she eaten when she injects for lunch?

In a rule of from from DAFNE, is that if you eat a carbs snack of over 10g carbs, if eaten around an hour before a meal, no need to inject insulin but if the next meal is longer then inject a dose to cover

As for Tea time, As littlesue already said might need adjusting the ratio's due to after she eaten she is more than likely less active and winding down for bed time, so not exercising off any of her blood glucose

But do sort one thing at a time, then give a couple of days to see how it effects her results... My self I would start with looking at the snack side of it all, and see how by changing or alter here effects the rest of the day..