Discussion in 'Parents of Children with Type 1' started by BrokenPancreas, Apr 27, 2011.
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We've never been told to do this and quite frankly would be shocked if a professional ever suggested this. For someone to suggest to run low on purpose to get a better A1C is ludicrous, IMO. An A1C is an important tool to managing D, and anyone that tells you to run low to get a better number should be fired. Seriously.
I am concerned about this advice.
It is one thing to aim for the best (ie. lowest) numbers you can reasonably achieve, while keeping your child safe from lows. That is what we're all doing.
And if you want to take it one step further (as our doctors in Germany did), then you can use an occasional mild low (ie. a number around 50 once a week) as a measure of whether you're trying hard enough.
But to deliberately aim for daily lows in order to bring down an A1C seems wrong on so many different levels.
I am sure hoping it wasn't a medical professional that gave this advice..
Oh goodness, just re-read your post and saw it was the CDE. I would contact the clinic tomorrow and ask to speak to the endo. If this is the endo's advice, then time to find a new clinic.
I was told that it was worth it to have lows if I they happened in the course of trying to get lower numbers over all, but not that I should try to go low.
I suspect that was the philosophy behind the advice. Especially since even a daily number below 70 if treated promptly would have little effect on A1c. It's a delicate line, but in my opinion, if your child never has lows, you probably are running them too high.
To be clear, they advised you to let her have one "bad" low a day on purpose? What was your daughter's A1c when you were given this advice?
ETA: To quote Sarah from the thread where this was first brought up:
I responded in the last post ... but in short... I know that our CDE asks about lows and expects there to be some ( moderate lows 50-70), I think as a sign that we are not intentionally running her high to prevent any hypos. Is it possible that that's what was meant by your endos?
Never been told this.
Obviously, we aim for the lowest possible safe numbers - which to me is in the low 80s (depending on what she is going to be doing - obviously if she is going to swim practice, 80s won't do but if she is sitting in the classroom or in front of a TV, 80s and 70s are fine here).
I have read that you should expect some lows if you are being diligent about obtaining the best numbers possible, but not to purposely try for a low.
Did they specify "bad" low?
While you may not be intentionally running her higher, 8.0 is on the higher end of A1cs for a child on a CGM, in my opinion. I think they thought that you could safely run her quite a bit lower.
I think it's possible that there was a complete misunderstanding here.
To my knowledge, there is no evidence that mild lows cause permanent damage. I asked Dr. Buckingham specifically about that at a CWD seminar, and that was his response. I've also searched for studies and come up empty-handed. It is certain that high BGs cause damage.
We all want to prevent lows, yet come as close to "normal" BGs as possible. I'm of the opinion that some mild lows are an "okay" price to pay for a lower A1c. It would frankly not be hard to prevent all lows. But it would come at the price of a higher A1c.
Put another way, I would (and do) tolerate my child hitting the 50s and 60s briefly a handful of times a week in order to keep his A1c low. I do not purposefully aim for those numbers, but they are a natural by-product of tight control. (I do not like the 50s and make changes to avoid them. 60s do not particularly get me hot and bothered.) I guarantee there is not a kid on here with an A1c below 7 who doesn't have weekly mild lows. And it's pretty likely that most kids in the low to mid 7s have them too.
ETA: I think you took the CDE too literally.
That is a good way to explain it. Especially if you are aware a low might be coming and are on the lookout for it.
In the DCCT patients in the "tight control" group averaged 2 episodes of hypoglycemia a week so severe that they required the assistance of another person. This was the group with the lowest incidence of long term complications. This might be what they mean. However, in my house, lows lead to highs, because when my 14 year old feels low, he will eat carbs until he feels better, often resulting in a very high blood sugar.
The DCCT study was done in another time - barely relevant nowadays. With today's technologies and modern insulins it is possible (even on MDI with no CGM) to do far better than the best group in the DCCT study did with very few or no lows that need assistance of another person.. :cwds:
Our new CDE likes that number. She says that if it's any lower than 7, for sure we have lows. Well, we do have lows, but they're not bad... okay, maybe the occasional "super low". Her A1Cs are always in 6.4 - 7.4 range. I don't understand when CDEs prefer a higher A1C than a lower one. I can understand when it concerns toddlers but not older kids, especially ones who feel their lows.
I don't think trying to hit lows, whatever that "low" is, is good advice. Just my opinion.
I wonder if the CDE was trying to make the point that Jonah made (much better) but chose a rather awkward and confusing way to state it?
The "one low a day" comes off as rather prescriptive and just plain odd in way that makes me think that the CDE couldn't possibly have literally meant that, kwim?
Our son's A1C's are almost always sitting at 8.0 and have been for almost 7 years. Our lowest was 7.6 and highest 8.2. That being said we have TONS of lows and it sure hasn't done a thing for our A1C's. We have way more than is good sometimes several a day. We also have highs but not nearly as often as lows. So my point is having one low a day probably isn't going to help the A1C much and it won't keep your child safe to aim for them.
Jacob has lows. He feels them, they get treated and his BG goes back up.
Do I like it? NO. I worry about him going low at night because he doesn't wake up from lows. I try to avoid lows at night, but during the day, his BG can fluctuate pretty fast. I do accept some lows during the day as just part of D. I will not try to push his BG average up just to avoid them.
I think trying to figure out the triggers that lead to lows is a sensible thing to do. If you know what tends to cause lows, you can do something about it.
The easy way out to avoid lows is to just cut back on insulin across the board. This solves nothing. It raises A1c and nothing is really figured out.
But you know, many of the health care personnel who advise us barely recognize how much daily life with diabetes has changed since the DCCT. They would still refer to it, thinking, " you have to have some lows."
M....No, I was not told that at all...and it didnt make a difference when Amanda was having some bad lows at preschool for a while there..(all better now..thankfully)..It did not affect her A1C to come down..in fact her last appt it was a little higher than last...I only have faith in one CDE at that office..the other one broke my confidence and repeated something I told her in confidence to my DH..remember that? Ughhhh!!!
I would never intentionally let my child have a "low"... a small one, or a major one. Ever.
I'd also fail to see how a temporary low would reduce the AIC, when you generally rebound to a crazy high... My guess would be those 2 numbers would offset each other?
We have never been told to do this. Actually after going on CGMs in 2008, our A1C's that had been in the low 6's went up some. They said it was okay because we were catching the lows before they got too low. I would not agree on having dangerous lows. Do they just mean having 70's ?
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