Hb1AC - what number is feasible?

JenniferM · #1 03-31-2009, 10:02 PM

Hello,

I know that we all strive to have a low H1AC for our children.

What has been your lowest H1ac but not a the detriment of a lot of low. We just got back from the endo and DS is at 7.3. I feel ambilivalent about it. On the one hand I am thrilled, on the other hand, I wonder how much more tweaking I need to do to lower that number.

I realize that we also have to take into account the quality of our children's lives. I am just curious as to how you all feel about it.

Thanks,
Jennifer

mmgirls · #2 03-31-2009, 10:41 PM

I think it reallly depends on the age of the child, if they feel their lows and what tools you have available.

I am ok with my 4yr olds aic of 7.8 and it has been lower around 7.4. When we get the cgm I will srtive for closer to 7.0., and take a lower aic as long as we o not experience lows.

Caldercup · #3 03-31-2009, 10:50 PM

I think it depends on the age and situation of the child. My son is still in a strong honeymoon, and, although we are very careful carb counters, I know that most of our success can be attributed to the fact that his pancreas is still kicking in.

After an A1C of 13 at diagnosis in Oct '08, his next A1C was 5.1 in January and the doctor wanted to lower his Lantus and adjust his carb ratios significantly.

I know we won't see these numbers for much longer, but... there ya go.
Eileen

Darryl · #4 03-31-2009, 10:54 PM

We're pretty aggressive, set a BG target of 90, and correct anytime BG is over 100 (except when expected after a meal). We use a CGM, and also Apidra which is a fast insulin that lets us correct more precisely. Our dd's A1C has been at 5.6% for the past 2 years, both during the honeymoon (TDD 10u-15u/day) and whatever phase we're in right now, possibly still some honeymoon - her TDD now ranges from 20u to 35u/day. Very few hypo problems, but a lot of attention is needed to the CGM readings and alarms.

hsmommyofmany · #5 03-31-2009, 11:52 PM

my sons is 8.3 but he was just diagnosed in january and his endo was very pleased with it since it was a decrease from 10.8 at diagnosis. my son is only 3 so his endo says he is happy with anything between 7.5 and 8.5 so we are in the desired range. i know ours is going to be higher when he goes back and i am worried about that but we have been having a rough time with high sugars, he is still honeymooning somewhat so we do lots of adjustments. i think 7.3 is great...you should be happy with that number.

Kirsten · #6 04-01-2009, 04:19 AM

Griffin is 4. We have had as low as 6.9 in the summer. It seems like increased (and consistent) activity helps to keep things stable (along with fewer viruses, etc). Right now it is 7.8. I would like to see better, but I try not to stress. I know it will improve in the summer.

Mom2Deacon · #7 04-01-2009, 07:13 AM

Deacon seems to be perfectly happy with being 8.1. He has been that for the past several appointments in the past year.

--Sara

hawkeyegirl · #8 04-01-2009, 08:02 AM

Jack's lowest a1C has been a 6.4. My goal is under 7, so as long as we hit that, I'm happy.

Sarah Maddie's Mom · #9 04-01-2009, 08:19 AM

Quote:

Originally Posted by Darryl

We're pretty aggressive, set a BG target of 90, and correct anytime BG is over 100 (except when expected after a meal). We use a CGM, and also Apidra which is a fast insulin that lets us correct more precisely. Our dd's A1C has been at 5.6% for the past 2 years, both during the honeymoon (TDD 10u-15u/day) and whatever phase we're in right now, possibly still some honeymoon - her TDD now ranges from 20u to 35u/day. Very few hypo problems, but a lot of attention is needed to the CGM readings and alarms.

Darryl, since our girls are close in age I always note your A1c posts with amazement. How big a role does your dd play in her D mgmt? Does she do her own self care at school and for sports and sleepovers and all that?

Darryl · #10 04-01-2009, 08:23 AM

It is worth reading the DCCT study for guidance on this issue.
DCCT: The Study That Forever Changed Treatment of Type 1 Diabetes

Half of the 1,400 T1 patients who participated controlled their A1C to under 6.05%.
The patient age ranges were from 13 to 39 years old, with no prior retinopathy or
kidney damage. The other half of patients had A1C's in the 7.5% range.

During the 10 years of the trial, those whose A1C was maintained at under 6.05%
had 50% to 70% less incidence of retinopathy and kidney damage, as compared to
the group with the A1C in the 7% range.

Although this study began with T1 patients at age 13, and does not cover younger
children, there are no studies I am aware of that have demonstrated that children are
more tolerant of high A1C's than adults are. In fact there have been reports in this
forum of children developing neuropathy and other issues by the time the reach their
teenage years.

While today's tools (fast insulins, pumps, and CGM's) make it feasible to safely achieve
an A1C in the 5%-6% range, many endo's are still advising their patients (along the
line of Hanas' book) that A1C's in the 8% - 9% range are safe for a young child. I don't
know what evidence such a recommendation is based upon.