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Does tight control mean lots of lows?

Discussion in 'Parents of Teens' started by mariaweber, Sep 30, 2010.

  1. mariaweber

    mariaweber Approved members

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    Every visit to the Endo gets worse. This time the A1C was 8.6!! That's the worst since diagnosis 5 years ago. We're using the pump AND CGM and still getting very bad results. I feel like I want to scream and cry. It's so frustrating.

    Sofie hates being low because it cuts into her workouts -- cross country, track, soccer. Does having tight control mean that you have to go low? I say no, but she insists that the only time she's had a good A1C (6.7 a couple of years ago) she was low at least 2 or 3 times per day and with her workout schedule, she just can't afford it.

    Nights seem to be fine -- basals are nailed. She wakes up pretty much the same as she goes to bed. It's during the day when she's in charge that the problems begin.

    She's a smart girl and understands the implications, but we're not getting anywhere. I understand that 14 is a difficult age for diabetes, but this is soooo bad.

    ARGGGGH!
     
  2. wilf

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    It all depends on how you define lows, and how you define tight control..

    But an A1C of 8.6 implies an average BG level of around 230. There's lots of room to bring that A1C down without risking bad lows.
     
  3. Sarah Maddie's Mom

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    Please don't be offended, but could she possibly be running herself high in order to keep her weight low?
     
  4. Mike&Dans.Mom

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    An A1C of 8.6 = about a 200.

    I can completely understand how your daughter would not want to run low during an activity. My older son is the same way.

    I would look over her numbers and try to correct one area at a time. Is she running high all day? Try working with her during one time period at a time. Maybe run closer to 120 at school during the morning. Then tackle the afternoons.

    From there, see if she can get herself more comfortable running at 180 versus 200 during exercise. That would be a step in the right direction. From there you could have her go to 160.

    My oldest is really scared of lows, he doesn't want it to interrupt what hes doing, so we took this approach with him and have managed to get him more comfortable at a lower number during activities.
     
  5. joan

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    I think tight control in a teen doing lots of sports could definitely mean more lows. I would not be striving for tight control right now, just better control. If you are not involved in her care maybe she needs some help. The teen years are tough. My son is a senior and I am finally beginning to see that he cares more about himself and is more careful with his d. One thing with the sports is that he doesn't like to be high or low during sports because he plays and performs much better with normal bs.
     
  6. Jacob'sDad

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    The potential is there for more lows with a lower A1c, but it's possible to have a low A1c without constantly fearing lows.

    I'm sure there are those with a higher A1c who virtually NEVER have lows and have developed a great fear of them. My son Jacob has had many many lows since DX and the great majority of them are quite uneventful. He says he feels low, we quickly do a finger poke, and if he is low, which is very likely, we treat with carbs and the great majority of the time, his BG comes up quickly.

    I would never intentionally run Jacob higher just to avoid lows. The health risks are too great.

    TIGHTER control can help avoid many lows. Big swings in BG can occur when BG gets very high, possibly from not catching the rise soon enough, and then a big correction is given. The potential for over and under correcting is greater the higher BG is. It's much easier to bring 150 down to 100 than to bring 350 down to 100.

    Tighter control doesn't have to require constant, enormous effort. It DOES take work, and it DOES take paying attention, but it doesn't have to be all consuming. Far from it. It does take work to get basal, carb ratios and correction factors set, and it takes paying attention to know if they are working or need adjustment. And it takes checking BG many times a day.

    A healthy diet makes tighter control easier. Knowing what foods are harder to manage and keeping those foods to a minimum helps.

    A CGM is really very helpful for tighter control because you can catch lows and highs MUCH sooner and take appropriate action BEFORE BG gets to a place that is harder to deal with. That constant BG data stream is really nice to have. You have much more data to go by to make adjustments.
    A CGM doesn't guarantee tighter control, nor is it necessary to achieve tighter control, but it can be very helpful.

    There are many type 1 teens (and adults) who think that the effort required to have good BG control is just to great. But NOT having good control is a lot of effort too. Constant high BG and a high A1c doesn't come without a price to pay. The physical toll will add up and cause much more difficulties and problems and TIME than spending effort on good control ever would.
     
  7. nanhsot

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    Yes, this. My son is very frustrated while trying to play at his optimal level when he is high or low, so he really does want to bring his numbers within range, so he's very motivated to stay out of the 200's.

    I'm curious what her night time numbers actually are, if she's in range for 8-12 hours of each day, it seems odd to me that her A1C would show an average of over 200, but this is all fairly new to me and I could just be clueless. It just seems like something isn't matching up if she's in range at bedtime and wakeup, she'd have to be going VERY high all day, and it's really hard to play sports at those levels.

    The teen years are definitely a challenge and sports in particular are a big challenge for us as well. It's a tightrope walk of offering help and letting them find their own way. Right now my son has it in his head that it's stupid to treat a low with glucose tabs (instead he thinks it's wise, apparently, to eat like a starving person in as short a time as possible :rolleyes: ). My point is that I do understand how hard it is try to tell them how to do things, better to find a way to work as a team.

    Given that, that's kind of how things roll around here, as long as your numbers look good most of the time, I'm hands off (though I do check the meter throughout the day), once your numbers start to creep up, then I'm stepping in a bit more. Just like you wouldn't let a kid drive with an drunk driver, or watch R rated movies at a young age, or whatever your limits are, we all have rules we give to set limits at this age. To me this is just another safety rule we implement.
     
    Last edited: Sep 30, 2010
  8. MrsBadshoe

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    If your daughter is a dedicated athlete I suggest that you as her to write or email one of the type 1 diabetic athletes. I just heard a speach from Ginger Vieria http://www.healthcentral.com/profiles/c/27511 about how she fine tuned her blood sugar/exercise routine. It was amazing. I think if athetic kids heard more of these athletes speak and try to understand what they are doing they might be more successful in their own care.

    If you'd like an email I'm sure my hubby has it.
     
  9. chbarnes

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    There are successful athletes who manage good control with a reasonable A1c. In general, it seems to involve frequent testing during sports and taking small amounts of short-acting carb. Many kids here use the "gatorade trick" and sip throughout practice. The most important thing is making frequent adjustments.
    It's not easy for a 14 year-old.
    Inspirational role models do help, particularly when they have written about their own struggles with management. Team Type 1 the bike racing team comes to mind.
    It does help to have an adult at practice to supervise. This may not be practical, but even a coach may tell a youngster to take a break and test.
    Good Luck
     
  10. alismom

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    Allison is a varsity athlete in three sports....diving, cheerleading and pole vaulting. Her last A1C was 6.1. She does not have frequent lows, however it does take some time to manage. Temp basals, carbs during workouts timing of meals and it's different for each sport. Not easy, but can be done.
     
  11. wilf

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    What I find hard to understand is why OP's daughter has such a high A1C despite having a pump and CGM. Surely it can't be that hard to manage the D when getting real-time feedback on BG levels.
     
  12. frizzyrazzy

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    this is helpful, how?
     
  13. hawkeyegirl

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    Yeah, it gets super easy to manage "the D" once you get a pump and CGM.
     
  14. Brenda

    Brenda Junior Member

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    OP made it clear that BGs were fine at night when she was in charge. The higher BGs are apparently happening when her daughter is in charge, at school and her activities. For reasons that are not clear, the BGs must be higher during the day. We do not know what the young lady is doing--underbolusing, not bolusing, overeating, etc.--to cause this. Perhaps she once had a bad low and is afraid of this so she is letting herself run high. Who knows? Mom is just hoping to rectify the situation.
     
  15. sammysmom

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    There is absolutely NO WAY you wrote that statement without full knowledge of how rude and condesending it sounded. Seriously you are not perfect with D matters. CGMS and pumps are tools, just like MDI....I sure hope no one digs up some posts on you and points out how you could possibly not "get it". If you find it "hard to understand" then I truly think that you are the one that needs a little bit of help. WOW, just WOW.
     
    Last edited: Oct 13, 2010
  16. Ronin1966

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    Hello mariaweber:

    The answer to you question is Y-E-S,

    It is a horrible truth of the DCCT study, which is ignored/overlooked by too many. By definition "tight control" means lows are far more likely.

    If we keep a higher level than some prefer, the likelyhood of those lows is much less. Higher numbers as a "buffer" in order to exercise is very common.

    To prevent lows, and stay sane... many do exactly as she is... and we are not "teens" by a long shot! It is frustrating for all of us...
     
  17. Ronin1966

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    Hello hawkeyegirl:

    You forgot the emoticons to indicate the joke. Perhaps this one would work...

    :rolleyes:
     
  18. Ali

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    Wish i could solve the issue but there are so many possible reasons. But with the CGMS your Endo team can download and find out where the highs are most often occurring and then work with your daughter to find out how to solve. If your Endo team can not do this then contact either online or in person a more experienced Endo or Endo team. I know Gary ??? does online/phone consults, hope some one can give you the name, or maybe another Endo in your town. Good luck, Exercise is hard and teen years are hard, it is so individual that all I can suggest is to work with someone who will be very hands on with your daughter. Good luck.:cwds: Ali
     
  19. NomadIvy

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    There's a cyclist with Type 1 who keeps a very tight control on his BGs. Google Type1 Rider. He's also on Facebook (Tony Cervati). Your dd might learn from him. Good luck.
     
  20. wilf

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    C'mon folks, do the math. An A1C of 8.6 translates to average BG levels of around 230.

    OP has indicated "the nights are fine". If we assume night averages are 150 for 8 hours, then that means the average for the waking hours is 270. The "daytime A1Cs" are in the 9-10 range.

    There is an issue here, but it's not that "tight control means lots of lows". It's that there is little control during most of the waking hours when DD is in charge.
     
    Last edited: Oct 14, 2010

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