Ever wonder if you may be missing lows?

[Ben'sMommy]

Ben's daily BG's are typically very good and his last a1c 3 weeks ago was 6.3. The doc is delighted but I'm a bit concerned that we may be missing some lows.

He normally doesn't have many hypos and although 6.3 is great it seems a bit on the low side for a 2 year old. Bens endo tells me not to worry but I can't help feeling like it's too good to be true?
Previous a1c's were 6.6 (July), 6.9 (April), 7.2 (January), 7.5 (October), 7.9 (June) etc.

All I can think is that he may be having mild hypos and rebounding before we see it? :confused:
He's checked ALOT throughout the day and his hypo awareness is excellent so I'm confused!
I want him to go on the 3 day CGM to see if it can answer my questions.

What do you think?

[TaeandTiff]

my son is 3 type 1 and i have/had it for 20 years post transplant. And I can tell you from personal experience there is little to no recovering from a low. It just gets wors and worse. The worse time for me is/was during the night. The longer I went, the worse I would get. I would wake up cring and in seizure. I can never, ever remember a time in 20+ years that I recovered on my own.
Kudo's on the excellent control. I can't wait to get my sons H1c's like that!

[pookas]

Hunter is 6 and the endo. really doesn't want him lower than about 7.5 becasue the tighter the control, the less likely to feel a low [hypo-unawareness]. He's at 7.8 right now, but I would like to see him a bit lower. You should go for the CGMS and see what it shows. It couldn't hurt, unless he gets uncomfortable w/ it.

[selketine]

I think there is no harm in trying the 3 day CGMS.

His A1c should correspond to an avg of what you're getting on the meter with him. I know William's A1c has routinely corresponded with an average of around 180 on his meter - so that makes sense (his A1c is 7.3 from a couple of weeks ago). Since I know his meter average (we test about 15x a day) then I think if he had a really low A1c it would tell me something is not quite right!

What is his meter average? 6.3 would be around a 145 average on the meter maybe?

Here is a chart:

The chart below shows the HbA1c test result as a percentage and the corresponding average blood glucose level.

HbA1c Average Blood Glucose (g)
4 65
5 100
6 135
7 170
8 205
9 240
10 275
11 310
12 345
13 380
14 415

[georgia]

Carol,
I wonder the same thing. Although our last A1c was high, 8.8 so Ifigure we aren't, but I told my husband if it is a good # we are missing something. I can see why you are worried. Sometimes I get lows at odd times and wonder if I am missing others. My nurses say the liver will kick out sugar sometimes, which she said is fine, the bodies way of protecting itself. Do kids always feel bad after a rebound, or could they happen and you'd never know. So many questions and so few answers.
I read alot of your posts and I think you are doing an amazing job. Keep your chin up, he is getting excellent care, and I hope you find an answer.

[Barry]

I'm a little suspicious of a lot of things, one being the entire medical profession.

A "normal" person's A1c is, I think, 4.5 to 5.

I've heard 7.5 and 7.0 and I think 6.5 as target BG for people on this board.

We havent had our first A1c, but 180 or so pre-meal test and 60 pre-bedtime test in the last 60 days have averaged 111. There's a couple of mid 60s in there at dinner, 10 or so test in the 70s at lunch and the most of the rest somewhere between between 90 and 140. (except for the day I bought regular Dr Pepper instead of the sugar free. Anyone ever supplied their D teenage child w/ a 2 liter of regular soft drink, not pretty)

Anyway, I faxed these numbers, which I'm pleased with, to the endo and get a message to cut back on the AM insulin. My point is, I feel they can live with the highs easier as the consequences are delayed (years). The lows carry a liability, exposure factor. I asked her, eye to eye, if she was treating him NOW the same as she would if she would be the one treating him 40 years
now and she said she was.

[coni]

Is the average of your meter readings inconsistent with the 6.3 a1c? If the a1c is a lot lower than would have been expected, I would be more concerned. If the a1c and meter averages track each other, I would be less concerned. (Notice I didn't say unconcerned. We're never unconcerned, are we?) Esme's a1c was 6.1 last appointment. I thought it was great; the endo has subsequently had us run her higher.

[Amy C.]

The liver can only imprecisely push out sugar for the rebound. My experience was that a rebound was very high, not say, from 50 to 200. It was more like 50 to 400.

If you are checking often, I wouldn't be too concerned. A CGMS is very interesting to do. I discovered my son would go to nearly 40 and then back up within an hour. This wasn't rebounding, but the normal fluctuation, all on the lower end of the scale.

[EmmasMom]

I had similar concerns when Emma's 3 month post Dx's A1C came back at 7.5, (the low end of acceptable for a baby) and her average on the meter was more like 210!!:eek: We were having an impossible time controlling her back then, and my guess is she was having undetected lows. The doctor pointed this out to us as well.
I think you have things well controlled, and maybe his A1C is just that good!!! What is your meter average? Is it close? Can you come help me with Emma for a while?;)
We have an appointment in three weeks and I'm crossing my fingers that everything will go smoothly between now and then. Last visit she had been sick for weeks and we had horrible numbers during summer vacations.:( I sooo badly want her A1C to be back in the 7's. I will be giddy if it is!!

Keep up the good, amazing, unbelievable work!!!

[momof2]

Wow Carol that's an excellent A1c - well done to you.

I often wondered if we were missing lows, and Ben was getting up in the mornings with levels between 3-5mmol. The levels during the day were between 4 - 7mmol. The nurse suggested decreasing his insulin slightly, as she felt he was having too many 'borderline' levels - i.e. regularly reading around 3 - 4 mmol before meals.

Ben appears to have become hypo unaware - he does not seem to experience any symptoms at all and we've had some readings as low as 2.9mmol, and he always says he feels fine!!! :eek:

We've now decreased his insulin slightly and his readings are still very good but average around 6 - 10mmol.

I think the CGM is an excellent idea!!

Let us know how it goes.

:)

[Ben'sMommy]

Ben's meter average is about 7.2 (130). (The UltraSmart is so handy for things like this!!).

I guess my biggest fear is that his a1c will keep dropping the way it has done. I do NOT want it any lower while he's still so young. I would prefer if it was a little higher actually. Is that weird? :o

His daily bg's are generally within range with his target set at 6.0 (180) (done by his diabetes nurse). He does have highs and lows obv but is mostly 'stable' (sorry for using that word!!).

I'm going to get him on the 3 day monitor as soon as we can. It can't hurt.

Thanks everyone. :)
Maybe I jut need to be happy about it.:rolleyes:

[selketine]

Well his meter avg is consistent with his a1C so that is a good start. I still think it can't hurt to try the CGMS and see if you are missing any lows. When they are that little it can't hurt to have that extra bit of info.

I don't think I could ever keep William at an average of 130 - he seems too sensitive to insulin and food - or perhaps it is some butterfly flapping its wings last Tuesday on the other side of the world.....;)

[Momof4gr8kids]

One of the things I have noticed is that Julia's A1C never has relected the meter average. The reason is that we check her 4 times a day, plus when she feels low, plus we do two night time checks a week, or we do them nightly when we are making a change. When Julia is low alot, like when we are waiting those 3 days to drop her lantus again it brings the average down quite a bit on the meter. Julia's last A1C was 7.1, but her meter refected that it should have been just above a 6.