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Disappointed in A1C

Discussion in 'Parents of Children with Type 1' started by Dvbo79, Nov 18, 2014.

  1. Dvbo79

    Dvbo79 Approved members

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    Our last A1C came back exactly the same as 3 months ago and we are nearly 2 years in and never had it under 7.9%. We see quite a few lows (also highs). He has the Dexcom and we can never seem to keep him at a steady number for very long. I'm thinking that maybe he is taking too much basal (10 units of Levemir) and that is why the number is so unsteady. I feel guilty because two years is a long time, I should have this down by now, and I want to do better for my little guy. BTW, our Endo is happy as long as we are under 8%. I'm just not satisfied with that number. Any helpful advice appreciated. Thanks.
     
  2. Sarah Maddie's Mom

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    I think with a 3 year old it's really hard to safely get an A1c all that much lower, especially if you are seeing a good many lows. That said, I think 10u does sound like a lot of basal for a little one, but kids vary quite a lot in terms of basal need so I'd only think about changing it if it is way, way more than 50% of TDD and hopefully with the endo's input.
     
  3. sszyszkiewicz

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    7.5% or less are the ADA guidelines....so you are really close. Just sayin' !!!
     
  4. Lori_Gaines

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    It is so hard with our little ones!!! Our endo is also happy with us under 8% due to the very young age. We are also 2 years in, and we have our appointment tomorrow. We just keep trucking along doing the best we can. With that said, it does seem like your basal is quite high, so it's worth looking into. My daughter's is about half that.
     
  5. mmgirls

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    10 units does sound like a lot to me for a 3year old. Do you see over night lows that have to be treated? or do you have to go to bed at a higher number to drift down? Or are the times that he goes more than a few hours without eating does he continue down?

    If you post some numbers and ratios I am sure we could give better advice!
     
  6. nebby3

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    I agree that 7.9 is not awful for a toddler. My dd stayed in the upper 7s in those years and only moved down to lower 7s around age 7. Things got easier for a couple of years then till puberty hormones began to kick in. I suspect it is very hard in MDI to find one dose that works for him all day. Even though my dd is no longer pumping I was really glad she did for those early years. Having said which. She A1cs were still in the upper 7s for those years but on MDI (NPH, not Levemir, back then) they had been in the 8s.
     
  7. Nancy in VA

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    When my daughter was a toddler, we weren't able to get her under 8.5% without a pump - she just needed variable basals that we just couldn't get with MDI. And when we went on the pump, our basal was about 4.5u - 10u seems HIGH for a little one. Have you done any basal testing at different times of day to see, especially around meal times, what's going on without carbs and boluses?
     
  8. Lakeman

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    Like others here I would not be so worried with a 3 year old. The guidelines get tighter as they get older. I am not so sure how too much basal would lead to a less desirable a1c. It might cause too many lows but then you would have to be over-treating the lows in order to get a high a1c.

    Do you have any guesses about what things you could change to get a better a1c? For us it was cutting out some foods we did not know how to work with. We are better at dosing for those foods now and have included them again.
     
  9. Snowflake

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    We had a similar situation for the first year and a half with our toddler -- hovering between 7.9 and 8.4. Our (former) endo was even more conservative than yours; she followed outdated guidelines and wanted dd between 8 and 8.5. Everything about D, including A1c but really everything, is just bleeding hard with a 2 or 3 year old, and you shouldn't beat yourself up!

    I second Nancy; the pump helped us a lot, especially with overnight control. We also had to survive a year in which DD got seemingly EVERY possible daycare bug on the planet, which wreaked havoc on her numbers.

    A quick question: Do you still send in your numbers to the nurse or CDE? I suspect that I'm in a minority of members here in that our family still sends numbers in regularly 2.5 years post-diagnosis, but I do think it's one factor that has helped us chip away slowly at the A1c (though we still have work to do for sure!) We always have opinions/make suggestions, but I think we've really benefited from getting our CDE's input a few times a month -- the CDE sometimes catches patterns where we might be more focused on events.
     
  10. GChick

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    I have nothing overly useful to add as God only knows what my numbers were like at three years old. I believe I still only had the option of a pee test back then.

    Anyway, for perspective... I'm 35 and just stopped using Lantus (which I understand is "fairly" comparable with Levimere) the end of last year, and at that time I was taking 17 units/day and at the time I had a feeling that that was too much for me.

    Granted there might be a lot of stuff going on in little kids bodies that there isn't in an adults, but I think only 7 units difference between an (ever so slightly overweight) adult and a small child is not exactly what I'd think would be a significant enough difference.

    Sure sure... every body is different and has different requirements and no one can tell you for certain without enough background that 10 units is "too much"... but I rambled on to just say that I agree with the others that 10 is quite a bit for a three year old. Only you and/or your doc can decide if its "too much" however... and if it is possible that you are indeed overcorrecting in order to allow for a drift back down, that can be a cause for a higher than ideal a1c.

    For that age however, I also agree that a 7.9 is not exactly horrible, but I can also understand that you can view it as disappointing if you feel you have been trying harder than a 7.9 would indicate.
     
    Last edited: Nov 19, 2014
  11. mwstock

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    There is no reason to feel guilt. You are doing a great job. Do not be so hard on yourself! I agree with the endo that anything under 8% is fine. I had this conversation with our endo today. I agree with the others that we did not see numbers under eight until after going on the pump. It can be done, but I would error on the side of caution with a three year old. A few years back, it was 8.5 for small children and the standard was lowered to 7.5 for all age groups. Managing type 1 in a child is a moving target. There will be periods of growth and illness. The only thing constant is change. It is a continuous learning and adjustment process. It does feel good when the A1C is good, but it is not a good measurement of your effort. You have to go into the endo appointment with that mindset. It is an added bonus when it comes back good. Over time you do get better at making adjustments and identifying patterns and reacting. Experience and education are valuable. It is important to do basal testing to make sure the long acting insulin is not too heavy. Equally important is knowing when to adjust basal or bolus insulin.
     

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