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Thread: What is the optimal range for the hemoglobin A1c?

  1. #1

    Default What is the optimal range for the hemoglobin A1c?

    Help us solve a family argument - what is the optimal range for hemoglobin A1c? What are the arguments against having one that is quite low?
    Corinne
    Mother of an 11 year old boy dx 7/08

  2. #2

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    I am pretty sure it depends on the age of the child. Our endo does not want Kaleb's super low because it could mean he is having a lot of lows. His is 6.3 and the endo said she does not want it any lower.
    Kristi mom to son, Kaleb 19 dx 12-15-07 pumping with blue PING 11-17-08 and daughter, Riley 13, non-D
    One by one the penguins steal my sanity.

  3. #3
    Join Date
    Aug 2007
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    Hamilton, Canada
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    Quote Originally Posted by Corinne Masur View Post
    Help us solve a family argument - what is the optimal range for hemoglobin A1c? What are the arguments against having one that is quite low?
    The optimal range is the lowest you can reasonably achieve without encountering severe lows and without obsessing about the diabetes to the exclusion of the important things in your life.

    The answer is different for every child and every family. Recommended ranges for children your age are around 7% to 8%, but it may become exceedingly hard to achieve such A1Cs as your son goes through puberty.

    Good luck!
    ________________________________________
    Wilf

    Proud Dad of Amy (18), diagnosed Aug. 2006 and getting MDI of Apidra and Lantus..
    and Sylvie (13); very happy husband of Shirla!

  4. #4

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    Quote Originally Posted by wilf View Post
    The optimal range is the lowest you can reasonably achieve without encountering severe lows and without obsessing about the diabetes to the exclusion of the important things in your life.

    The answer is different for every child and every family.
    I just wanted to say that is the best response I have ever heard! I'm 19 and my endo is fine with an a1c around 7.
    ~Rae~
    20, dx'd 3/1998
    Pumping untethered: MM 722 and Lantus
    CGMS 11/2007
    "Don't tell God how big your mountains are, tell your mountains how big your God is."

  5. #5
    Join Date
    May 2008
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    Philadelphia
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    There are three answers to this question

    (1) The lowest you can achieve without significant hypglycemia.

    (2) What your endo is OK with.

    (3) What the human body is designed to tolerate, and which will likely keep a child safe from complications of D. This is more a matter of science than opinion, and the best data we have is from the DCCT study. The complication risk for retinopathy based on A1C in figure 1 of this article: http://www.mendosa.com/minimal_variability.pdf. From this you can see there there is no "right" answer, it's just a matter of how much risk is acceptable.

    Of these,

    (1) is the only realistic answer, but leaves room for improvement by employing the best available methods, attentiveness, and technologies.

    (2) is meaningless in my opnion, unless the Endo recommends (1) and provides the training and support to help you minimize A1C safely. Endo's recommended A1C is particularly meaningless if they copy it out of a book written be any of the renowned diabetes book authors, where A1C's are recommended by age rather than by choice of BG control techniques.

    (3) reflects reality.

    The best answer, however, is that A1C an indirect measurement of BG control, representing a 3-month average. As the study linked above shows, variability is also a key factor. We don't shoot for any A1C, rather, we shoot for keeping BG in the non-D range as much as possible. I believe a better target than A1C would be to keep BG in the 70-140 range as much as possible.
    Dad to Leah and Anna, married to Pam
    Leah is 16, dx 1/1/2007 at age 8. Omnipod since 2007, Guardian CGM 2007-2013, Dexcom G4 2007-present. Sang the National Anthem at the 2013 JDRF Walk!

    CGMS Calibration - DCCT: The Study That Forever Changed Treatment of Type 1 Diabetes - Improved Glycemic Control in T1 children Using Real-Time CGMS

  6. #6
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    Jan 2006
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    Quote Originally Posted by Darryl View Post
    I believe a better target than A1C would be to keep BG in the 70-140 range as much as possible.
    Yes - I totally agree...your a1c is a snapshot of all your blood sugars averaged together. So highs averaged in with many lows can give you a wonderful a1c but horrible blood sugar management.

    I think if your child is on a cgms then trying to keep the blood sugar in range (hence getting a low a1c) is still not easy but at least lets you know that you are not experiencing a ton of lows just to get that pretty A1c number.
    Carol G.
    mom to William, age 11, dx'd 3/04 and started pumping 10/04 - Animas 1200. Animas Ping started 01/09; cgms Navigator start 4/6/09; RIP Navigator 9-1-11, Dexcom 7+start 10/11, G4 start 11/12.
    and mom to Rod (15) not D

  7. #7

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    I agree with those above. The A1C is an important measure but its more important to know what type of "Range" that is reflecting. If you achieve a 6.5% but constantly have swings from 50 - 300, that's really not good. If you achieve a 6.5% because you are maintaining a 110 with swings sometimes into the 70s and 150s, that's a good #.

    For us, the lows are problematic because Emma, even after 3 years, shows no outward signs of a low, so we try to run her a little higher to avoid them. The CGMS has helped us run her a little tighter
    ~Nancy
    Mother to:
    Samantha - 17
    Michael - 13
    Emma - 8 (2/16/05 dx 3/07, dx Celiac 1/10) - Pumping with a Pink Animas Ping!
    as of 9/07
    CGMSing as of 3/26/09 with Navigator, 9/14/12 with Dex 7, 12/5/12 with dex G4

  8. #8

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    Quote Originally Posted by wilf View Post
    The optimal range is the lowest you can reasonably achieve without encountering severe lows and without obsessing about the diabetes to the exclusion of the important things in your life.

    The answer is different for every child and every family. Recommended ranges for children your age are around 7% to 8%, but it may become exceedingly hard to achieve such A1Cs as your son goes through puberty.

    Good luck!
    Great answer!
    I too agree that you want to be as low as possible, but not obsess about the number or your child going constantly low.
    This is the written chart our endo has as reference on each of our A1c letters:

    A1c Average glucose Interpretation
    4-6 under 135 Reference range
    6-7 135-170 Goal-excellent
    7-8 170-205 Good control
    8-9 205-240 Fair control
    9+ 240 and above Needs work
    Diagnosed June '05
    Pumping since Feb '06
    Animas Ping
    Dexcom Study







    My current position:
    CIO...CHIEF INSULIN OFFICER

    "Life is under no obligation to give us what we expect"...Margaret Mitchell

    "Make it work"...Tim Gunn

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