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What is a realistic A1C for a 12 year old boy? And how do you get there?

Discussion in 'Parents of Children with Type 1' started by suej, Aug 17, 2014.

  1. suej

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    My son's endo from the first day of diagnosis said he should aim for HbA1C for <6.5%. He was 9yrs at the time and we are coming up for 3 years post diagnosis now. He has managed to achieve that (just) with 6.4% for the last year. I feel as if half or more of my (rather tired) brain is taken up with trying to keep up with basal and bolus changes required for early puberty, different activity levels etc and he actually does really manage well and cheerfully mostly, and is completely independent at school. Nights a different matter. He does not wake to alarms and I'm not sure that even if he did he would be awake enough to do a sensible correction. I don't feel at peace with his control. We are always reacting to predictive lows, or heading off a high or sighing over a stubborn high (is it a set problem, ineffective insulin, a fat high, inactivity etc). I am so grateful for GCM and pump but please can I ask all the wise people out there the following?

    1. What HbA1C is achievable in a 12 year old boy with GCM and pump? I would so like to reach a "normal" range of just under 6%
    2. Do you perhaps have 5 (or any number) tips that make the most difference to your child's control to make life with diabetes smoother?

    Thank you
     
  2. KHS22

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    I'm not very far into this with a child, but also live with a T1D adult. And, honestly, my sense is that it rarely gets "smooth". Just when you think your settings are good and you have a handle on things, they grow. Or become more active. Or get sick... as you know the list goes on.

    I am on a daily basis, downloading her #'s and making changes. I thought it would slow down after she was out of honeymoon. It hasn't.

    My husband, its a bit more stable because he doesn't have the growing to complicate things. But even with him, at least on a weekly basis we evaluate his settings etc.

    I know its exhausting. I'm exhausted too...

    Sorry, no comforting answers... just I know what you are going through...
     
  3. Nancy in VA

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    Less than 6.5 is an unreasonable goal for most diabetics. My daughter has what her Endo calls a "textbook" 2 week graph and her a1c is typically 6.9 or 7. And going into puberty, the hormones are gonna go crazy and you're likely gonna be lucky if you keep him under 8.
     
  4. sszyszkiewicz

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    The new ADA guidelines for kids/young adults is 7.5 or less.
     
  5. DavidN

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    I read the title of your post and thought your A1C would have started with an 8. A 6.4? What the heck is wrong with that, particularly at 12 y/o?
     
  6. KHS22

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    Agreed, 6.4 is awesome!
     
  7. swellman

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    Personally I think a 6.5 is great. The ADA would agree as well as our endo. I think any endo that suggests lower would be more attuned to type 2 than type 1 IMO.
     
  8. suej

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    Thank you for your replies, I really am grateful for the 6.4 and reassured by your responses, but am aware that things are only going to get trickier as he is now definitely out of honeymoon and going into puberty. We (him and me) just seem to have to work so hard at it and it feels like it takes up too much headspace. I feel a bit obsessed. I go through his d day with him every day (he hates that 10 mins) and we agree on adjustments.

    Thank you KHS22 for your insights, it must be really really tough with a pre- schooler (amazing A1C) and a husband living with diabetes.

    I just wondered if there are any really important tips that I am missing that would make our lives easier that you don't find in books? A bit like an idiots guide of really important stuff that your endo can't tell you?

    Like what I have learned from this forum:

    1. We have to prebolus for breakfast and even then may spike
    2. Low GI causes less spikes
    3. Try for good control (5-6) overnight as sugars move slower and it a big part of 24 hours so will help A1C, but narrow glucose limits means less sleep
    4. Keep good records ( Not fun or easy and on a tired day I don't do it, and my son is at this stage of his life absolutely not going to do it)

    What works best for your children? I know diabetes varies so much but there must be some common golden threads

    Thank you
     
  9. Christopher

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  10. nebby3

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    Your A1c is wonderful for now but I'd worry that you and your endo may have unrealistic expectations heading into puberty(from what I've heard; my dd is 12 too). I'd also worry about you and your son getting burnt out, this is a marathon and you don't want to lose it at the end because you are doing too much now. The low goals your endo set for a 9yo concern me. Not that it isn't great to have that control but it seems unrealistic for a kid.
     
  11. Junosmom

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    My 12 year old son's A1C was 6.4 at the last appointment and our Endo congratulated us! If I understand the CDEs feedback, they don't often see a lot of patients with A1Cs in that range at his age. A1C is important, but from what I'm reading, standard deviation is more important. That is, you can have a good A1C by having significant lows, and so that number in itself doesn't mean good BG control. It is important to not have the big, big ups followed by significant lows, if I understand correctly.

    I'm fairly new at this (8 mos) but working hard. To not burn out, I take breaks sometimes from reading stuff about diabetes, but when I'm working on it, I pick just one aspect to work on. Like - night time basal or breakfast spikes, not the whole day. Makes it easier for me to not get overwhelmed. (I still do sometimes.) I also fully expect that he won't always have a 6.4 (which I consider awesome, btw) and that puberty will teach us humility. It is just now starting.

    I am sorry to see all these posts about endos who think the best approach is chastising rather than teaching.
     
  12. Sprocket

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    My daughter is 12 and her most recent AIC was 6.8. Her endo and team were very pleased and said they wished all their patients were there - that we were in the "upper echelon" compared to their patients overall - so a 6.4% is outstanding IMO for what it's worth.
     
  13. suej

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    Thank you for all the support, and Chris for the direction to that post - a mine of experience that I had not found. Will just keep on swimming:smile:
     
  14. badshoe

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    To me this A1C a Your Diabetes May Vary thing.

    Numbers as a focus can set your family up for feelings of failure. Some kids may still be producing insulin, other may not. There are big difference in living with D at adolescence - Growth hormones are killers of stability. I think we changed basal rates every 6 weeks or so through adolescence. My two cents is stay engaged, help promote independence through the rocky forgetting parts and focus on coming out emotionally whole. The numbers will sort out in time.

    I take the view that the goal is not a number, it is what the goal was before diabetes:
    http://www.ydmv.net/2008/08/what-is-your-goal.html
     
  15. Sarah Maddie's Mom

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    I think the level at which "it takes up too much headspace" is going to vary from family to family and from life stage to life stage. The trick is to find the level of diabetes engagement that protects both your child's physical health AND their emotionally wellbeing (not to mention your own). I don't see the A1c as the ultimate measure of successful management of Type 1 in and of itself. My philosophy in most things is to look a the whole kid - is she doing well in school? Is he thriving socially? Is she stretching herself and taking risks at school and in sport? Is he managing his diabetes in an age appropriate way when on his own? Are we all getting decent sleep? All these "measures" and so much more go along with the A1c to let me know if we are living well with diabetes. It's the big picture, a marathon pace and a willingness to put the whole kid first. Just my 2 cents
     
  16. BittysMom

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    You mentioned "keeping good records". Being that you're using a pump and cgm, I'd skip any logging. When I stopped logging we gained freedom and got some time back from all-consuming D work. I had to force myself to stop because I thought it was slacking and would be detrimental, but our A1c hasn't climbed at all. There may be moments where it would be helpful but generally speaking I find cgm data information enough.
     
  17. Junosmom

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    I was wondering what records others were keeping, for example food journals? At the beginning, I kept lots of logs but not so much anymore. Everyday is different anyway with puberty. I have made a revolving menu for breakfast so that the carbs are almost always the same to eliminate the morning calculations at least. I don't keep food journals anymore.
     
  18. suej

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    I am still keeping records of I:C ratios (so a food or carb journal and I also note when I think high fat to flag) as they change so much with activity (as does his basal) and vary during the day. And my tired brain forgets what worked. In the recent 3 week winter holiday, other than a short snowboarding weekend, he was often very quiet, reading, and his insulin requirements went up 50%, now dropped back to a month ago levels with school and 2-3 hours of sport a day. As for getting into a car for 6 hours to travel- need at least 150% TB and 150% of a usual bolus so have made note to self.

    Am thinking about bolus wizard - have not ventured there as I wanted him to know the principles behind what he is doing and with variable activity I wondered if he would have to override it often. Is the bolus wizard game changing?
     
  19. BarbDwyer

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    I don't exactly know what a bolus wizard is but once my son did the calculations by hand long enough to know what it was and how to do it we made a spreadsheet. He just has to plug in his carbs and blood sugar. It has all the 1:C factors on it that he would use - he just has to pick one. I think he uses that spreadsheet a lot (it is on his phone) but I wouldn't say it was a game changer for us but with no pump there is no overriding. He figures it out each time anyway. He is 13.
     
  20. MomofSweetOne

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    We did MDI for a year and once we switched to the pump, we've used the bolus wizard non-stop. It makes life so much easier, but there is a place for teaching the kids when to override the recommendation. I think with teen burn-out being so common, I'd lose the calculations if you know he understands them already. Stick to the basics (or not so basic) of things like testing, dosing, and if possible, prebolusing. There's no need to calculate endlessly.
     

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