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A1C - do you and your Endo go by the guidelines

Discussion in 'Parents of Children with Type 1' started by mom2two, Feb 3, 2010.

  1. mom2two

    mom2two Approved members

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    I see that for kids age 4-6 yrs of age a target of 7.5-8.5 is where they want you(i believe I saw that on the ADA site). So if you are below that(without a lot of lows) does your endo discourage it? Since starting the Dexcom we have been able to let him run on the lower end of his range and am worried our endo won't like it?!?! I know silly right? SO how does your Endo/Clinic feel about lower a1c's with younger kids USING a cgm. And lower meaning high 6's.
     
  2. hawkeyegirl

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    Our endo appears to be of the opinion that lower is better as long as you're not doing it at the expense of frequent or prolonged lows. He can see from the CGM that that's not happening, so he's not worried. Even without the CGM, he wasn't advocating a 7.5-8.5 range for us. I imagine that's higher than he would want to see.
     
  3. Beach bum

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    If your child can safely run at the lower end of their range, then that's great. I don't see it as being a problem as long as your child is not having frequent or extended lows.
     
  4. mom2two

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    Thats great!!! I was so nervous about lows before the CGM that we couldn't get anywhere below 7.3 so he probably wouldnt have been happy with us :eek:
     
  5. mom2two

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    Right, the CGM HELPS so much!
     
  6. BrokenPancreas

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    Your endo is fine with an 8.5?
    It's amazing how endo's differ in what number they want.
    What state do you live in?
     
  7. mom2two

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    I don't think they would be "ok" with, its just there guidelines. I believe they go by the ADA guidelines.
     
  8. Lee

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    That is the standard range for little ones...it is posted on ADA, in the Pink Panther, etc...they do not want to risk potentially dangerous to the brain lows in little tykes. Remember, there is a big difference between 6 and 7 year olds versus 23 month olds and other toddlers.
     
  9. Becky Stevens mom

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    From the book by Ragnar Hanas:

    Toddlers and preschoolers: (<6 years) ( < 8.5 but > 7.5 )

    school age (6-12) < 8

    And yes Darryl :) I know that this is an old book LOL but some of us old fuddy duddies like me still refer to it
     
  10. hawkeyegirl

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    It's funny, but we were never given guidelines. I think our endo approaches it on a case-by-case basis and considers all the factors involved. I have no doubt that he'd be turning cartwheels if some of his patients managed to pull an 8.5.
     
  11. Charliesmom

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    Ours likes it around 7. She was okay with the 7.5 yesterday but I know she would like to see it lower. :cwds:
     
  12. Toni

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    DN was diagnosed at 8. Endo goes by the guidelines put out by Association of Endos -- forget the initials of the organization offhand -- but the recommended A1c guidelines are substantially lower than those mentioned on this board. She wanted us to aim for 6.5 and below; she recently mentioned she would settle for 7s, low 7s when teens take over their own management, or, as she put it, when teens "first" take over their own management. For toddlers, babies, I assume her target is higher. We have been able to meet the guidelines... don't think I do more than other parents on this board who have higher A1cs. So far, her body is cooperating.
     
  13. SarahKelly

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    ours doesn't even mention the A1C as I think she doesn't want it to be the focus of our care for Isaac. He's not yet two so for her she's looking at trends during the day/night to make sure he's not spending too much time either high or low during specific times. I think eventually it may be discussed but she tends to be able to pinpoint areas that are going well or need tweeked without an A1C #. However, I think his range is a lot higher than most of your kiddos (100-200) as they're so fearful of lows at his age.
     
  14. frizzyrazzy

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    ours always says Under 8 is fine. grrr....so when we've been under 7 he sort of doesn't like it...which ticks me off. Last endo appt Ian had an abysmally bad a1c which the dr proclaimed "just fine" (it was nearish to 8) I suppose I should be looking for a new dr but honestly, I rarely have to deal with the endo anyway. I told him my plan is to be consistently at or under 6.5 by the time Ian reaches puberty. I am hoping to have that once we get a CGM.
     
  15. canadianmomto6

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    We got a big pat on the back when Liam was 7.8, but then I decided to be more aggressive with setting better target ranges and when he came in at 6.1I was reprimanded. We definitely have different ideas of target ranges, but I am learning to listen to what they say while we're there and then just keep on doing what I do after we leave the office...like the penguins in the movie Madagascar..."Just smile and wave boys, smile and wave." That's my motto.
     
  16. Darryl

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    In reality, it doesn't matter what guidelines an endo, a diabetes author, or the ADA sets for an A1C target. All that matters is what a child's body can tolerate. A child's body is designed to tolerate BG's between 70 and 100 fasting, and at most 140 post prandial. This corresponds to an A1C around 4.7%. Any excursion outside that range, no matter how small or how brief, can be damaging. No endo can claim otherwise, and if they do, they are contradicting all available evidence.

    Since we can not maintain A1C's of 4.7%, we accept certain degrees of risk as A1C (and variability) increase. The only responsible guideline an endo can set for a T1 child is "as low as we can make it while avoiding hypoglycemia".

    There have been no formal studies of children under the age of 13 which prove that A1C needs to be kept under 7% to achieve low complication risk, but extensive studies have proven that 7% or less is required for every other age group. Many endo's spread false information that young children are "protected from the effects of high BG" but there has never been a study showing that to be true (one endo hears it from another, who hears it from another, who read it in a book...).

    This summary article on the DCCT study provides in Figure 1 a chart where one can essentially target an A1C along with an estimate of complication risk based on data from more than 1000 T1 adolescents and adults: http://www.mendosa.com/minimal_variability.pdf.

    For those fortunate enough to be able to obtain and utilize a CGM, it is usually possible to achieve <7% A1C safely at any age, so especially at the youngest ages Endo's should be promoting CGM use in my opinion. Several parents of infants and toddlers here at CWD use CGM's with terrific results.
     
  17. Flutterby

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    A1c for little ones needs to be on the higher range because if little ones are spending to much time in prolong lows the brain isn't getting the energy it needs to grow.. That is a fact. If a small child is constantly low, in the state of hypoglycemia, they're not going to grow and learn they way they need to. Kaylee's endo never gave us an A1c to be under.. she's never been above the 'recommended' A1c range. I try to keep her A1c as low as possible, and which is safe for her.. we all do..

    Most people (if not all)that have diabetes will NOT be able to achieve an A1c of a person that doesn't have diabetes because a person that doesn't have D doesn't have large spikes after eating.. the insulin in the human body works different that the insulins we give our children. Trying to acheive an A1c in the 4s/5 isn't going to happen very easily and without the expense of extended lows. My non-d daughters last A1c was 4.9.. that is an average bg of 97.1.. Kaylee's current average on her meter and cgms is 160, which is a 6.67 A1c.. her lowest A1c was 6.6, (aside from dx which was 6.5) it took a lot to get there.. hoping to be in the 6's this time.. we have another month an half, anything can happen.;)
     
  18. wilf

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    I think this is your opinion. I do not share your opinion at all.

    In effect you are stating that any A1C over 4.7% (or any BG over 140 "no matter how small or how brief, can be damaging")..

    I'd like to have you present the scientific or medical reference that comes to that conclusion, before it starts getting presented here as fact.

    I think you are overstating things in a manner that is irresponsible, because it will make people feel anxious or inadequate when in fact they are doing just fine.
     
  19. Charliesmom

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    I wonder if endos think that way because they are dealing with so many people that test bg the bare minimum so there is a high chance of many undetected lows so they are overly cautious.
     
  20. jules12

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    I think our endo goes by the basic ranges that are mentioned here but I also believe they adjust for each individual person and the care they receive. I was very upset because we had a high a1c after we had to make a huge adjustment for us. He was glad I was upset and care but said for other patients he would be thrilled with that number.

    I think it is important that they look at more than just the number. Ask what you do to bolus, offset activity, etc. He also downloads the pump/cgms so he knows how compliant or not we have been with changing sites, etc.

    A1c is a good guide but I think endo's need to look at the whole picture.
     

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