Young children's A1c range

I honestly don't think hard work has a whole lot to do with A1Cs. At least for me....

Before puberty things were pretty manageable and I had A1Cs in the 7s with a moderate amount of effort. I used a pump and then a CGM at age 13. I tested myself around 10-12 times a day and my parents tested me around every 2 hours at night. We weighed all my food at home and when I was out with my parents.

Then puberty happened when I was 14 and all hell broke loose. All of a sudden my basal needs varied from 6 units to 60 units a day with no pattern whatsoever. I also wanted more independence and was sleeping over at a friends house at least 1 night a week and going away for the weekend for sports. We worked sooooo hard. I was in constant contact with my parents while trying to be a normal teen--- and it was tough when all I wanted was to pull away from them. I was testing 15+ times a day while wearing a CGM. When I was home at night my parents tested me basically every 60-90 minutes and adjusted basal. While away I had to set an alarm to go off every 2 hours and call my parents. I swear almost every day we saw 40s and 400s. At that point my A1Cs were in the 8-9 range and we were thrilled with that. We could not have worked any harder or made better use of the technology we had. I don't think puberty is that tough for everyone but some people with type 1 do see those crazy varying basal needs that make it difficult to manage.

Things have gotten so much easier in the past few months (I have a theory that I was in the tail end of puberty until very recently---I randomly grew 1.5 inches last year). I have A1Cs in the 5s with 1/100 of the effort from when I was younger. My carb ratios are basically static and basal does not vary tremendously.

So, I think it is a bit insulting to say all it takes is hard work to get good A1Cs. In my experience the level of effort (above a certain point) put in does not have that significant of a correlation to the A1C.

 

We don't have any sort of A1C goal. We muddle through the best we can. We've had a few not stellar ones. Usually due to illness, step was horrible it took almost a month after to get back into any sort of pattern. I'm happy as long as I know she's tried her best. There was one where she really hadn't been and it reflected. She reigned it back in a bit and the next one was better.

I'm not going to micromange her life. Saturday night the girls had a potato party. Yep a party with everything potato, fries, hashbrowns etc. Carb festival. She went, she guessed, we fixed it later. I wake her up when needed. I wake up a lot more times than I check. I try to ask myself is it because of a real reason or just because I'm worried. If it's just me then I don't do it. She's a teen, she sleeps in late on the weekends. Do I sit for hours and look at the clock hoping something horrible hasn't happened behind the closed bedroom door? Yep I sure do. Do I go in? Nope.

The CGM is a really amazing tool. You can check like mad and they don't know it

 

To your original question, of what range does your endo want your child to be in...

My son was 3 1/2 at d/x about 9 months ago. We were told that his A1C goal was to be under 8%.

I also wanted to do better than that, because in the haze of post d/x reading, googling and sleepless anxious nights, I scared myself silly with the complications. So I knew I wanted his range to be tighter than what was recommended.

We have tried to keep our son in what is a normal range for non diabetics - our bg goal is between 4 and 7. We were told that it should be from 6-12, but I just couldn't adhere to that as it would have caused me too much anxiety.

We are still 9 months out and still honeymooning I think, although his insulin needs have crept up to just over the 50% of weight in kilos calculation for honeymoon. Our last A1C was 5.8 - and yes a few lows (maybe 2 or 3 per week), but none of them very low (most in the range of 3.5-4). To me, the risk of those lows is less than the risk of running my son in the 6-12 (later changed to 6-10) range at the moment. I say 'at the moment' because I know full well that we have been having it very easy.. that I have put in far less work and energy than many of the people here whose A1C's are in the 7's. I don't know if it's the honeymoon, or luck with his physiology/age, but right now my son is pretty stable, easy to manage, and predictable given a dosage of insulin. So keeping very tight numbers is a risk I'm willing to take for now.

 

Our endo range for young children was 8-8.5. This was 11 years ago (pre-CGMS), the reasoning was to avoid undected lows since glucose is so important to the developing brain.

We set a goal at every appointment with out endo. They will not less us set a goal of a certain a1c. Having a low a1c doesn't necessarily mean good control.

Jess has never had an a1c in the 6s, and I am good with that (a lot of mid 7s, and a few lowers 7s). Our goal for that is to do the best we can while still allowing her to be a child and keep us from burning out.

She is now 12 and spends the nights with friends. I make her be 170 at bedtime when she isn't home because even though she sets an alarm for 2am I don't know she will actually get up and check. When she was younger, we allowed her to have cupcakes and candy at bithday parties.

Most days we check 9+ times, and usually once in the night. The is no way I could function day after day if I was getting up multiple times over night. I just wouldn't be healthy for me.

 

In a post a few months ago you said that you weigh everything your dd eats and drinks. Because I have a 15 year old that caught my eye and I wondered how you manage when you travel or when she's with her friends or eating out?

 

I'm sorry my post upset you. But people saying my daughter and other typev1s achieved their A1Cs due to unexplained lows and not good management upsets me. I'm sure there are people who get lower A1Cs this way. But that doesn't apply to all diabetics.

 

Oh, you didn't upset me. That was more of a general comment about the notion that A1C is all about the work you put in. I may have phrased it poorly.

I totally believe that it is possible for some people to maintain an A1C in the 5s or 6s with a fair amount of effort and minimal lows. I just don't think it is possible for everyone. And (as evidenced by my own experience) the ability to do that changes over time.

Regardless, I think it is great that your daughter has an A1C of 5.8%. Especially in a teenager, that is very impressive :cwds:

 

Where exactly were people saying that?

 

Absolutely - we've been through easier times and much harder times to keep BG's under some sort of control. We're currently going through a patch where EVERY number is a surprise - good or bad..

 

ADA recommnedation

First I agree that after a certain amount of effort, is kinda hard to keep A1C below a certain value. We had 4 great years at the 7% level, and from 9 months since now (starting at the 14th birthday) we are at 8-9%, even with a way stricter diet and controls. We plan to move to CGM to see if we can cope better with that.

Now, regarding the A1c number as a target, as the original thread was, there's an ADA web page that of course I cannot find right now, but I've found a reference from the Mayo Clinic:

http://www.mayoclinic.com/health/type-1-diabetes-in-children/DS00931/DSECTION=tests-and-diagnosis

Quote:
"The American Diabetes Association (ADA) generally recommends slightly higher A1C levels for children and teens than for adults, because children are less likely to notice the symptoms of low blood sugar levels. For children younger than age 6, the ADA recommends an A1C of less than 8.5 percent. In children between ages 6 and 12, the recommendation is for an A1C under 8 percent, and teenagers are advised to try to keep their A1C under 7.5 percent. "

In short:
Less than 6, less than 8.5%
Between 6 and 12, less than 8%
Teenagers. less than 7.5%.

And if I recall well, Adults less than 7%.

 

I have a newborn... if I wasn't testing her I'd still be up anyway lol. Like I said, I'm used to it. I feel so tired when I get more sleep than what I'm used to, like when my husband decides to be the one testing her at night. The next day im like the living dead.

 

I have felt like this in the past. Not so much lately. I think though that that more tired feeling when you sleep is actually a sign that your body is exhausted and is being pushed beyond its limits.

 

i believe this is the guideline that Ashleigh's endo follows. I know on her discharge papers it always says "A1C goal < 7.5% (hope that's the less than symbol. i googled it)

 

I agree, and would add that with a CGM you may even try to give pumping another go. I know I was ready to run over her pump - repeatedly - with our 15 passenger van for the first six weeks she was on it. We did not have Dex then and it would have made such a difference in ironing out the basals. Now we LUV the pump!

Pumping in conjunction with a CGM solves so many of the lows issues; you can reduce/turn off insulin when you see a low coming on the CGM instead of feeding insulin. Instead of doing five checks at night (BTDT) and exhausting yourself (also BTDT with the preggers and newborn thing with a T1D - so wish we'd had a CGM in those days!), you can correct for a high or low and monitor the CGM to see how she's trending.

Example: DD was running low tonight. Dex alerted me; tested; 50. Treated and reduced basal by 50% for an hour. She's leveled out at around 140, and I'm content to leave her there for a while since she was that low. When her temp basal ends, that should bring her back into range over the next couple of hours. If not, Dex will tell me. If so, I get to sleep . Last night, during the same period of time, she ran higher, around 170. Dex alerted me; I corrected, and I was able to see how she was trending. She leveled out nicely in range and I got some much needed sleep.

Dex is very simple to use, and a wonderful tool to have in the toolbox.

 

Yes for now, but the newborn will grow up. My kiddo was dxd at 11 month, literally a month after she finally started to sleep through the night. I was used to it too. I kept it up years before I realized how it was really impacting me.

 

If Gary Scheiner moved in to our basement AND we limited my son's diet to cheese sticks and cinnamon, and I'm pretty sure we still couldn't get his A1C under 6.5. That's just the way things are right now.

 

You jest, but there's no question - an A1c of under 6.5 is absolutely achievable but at a price. Generally the conversation goes like this:

"Wow, that's a crazy low A1c. What's your secret?"
"No secret. We just stay on top of things and try to manage as well as we can."
"That's great - do you use exercise to help?"
"No, my kid doesn't play sports - it wrecks havoc on blood sugar"
"Do you limit carbs?"
"No, not really. Though we don't eat pizza, or pasta, or bread, or dessert, or refined sugar or hight GI fruits - but that's just how we like it."
"Oh, so when your kid visits friends..."
"We like to have her/his friends here"

well, at least that's my impression, gleamed from years of listening.

 

Yup, that sounds about right from what I've heard as well.

 

Not ours. We don't restrict anything. We have pancakes and waffles for breakfast and other things. We superbolus for breakfast but still see spikes into the mid to upper 200s. Lunch is normal food - hot dogs, PB&J, microwave pastas. Bus snack is a fusion lite and a cereal bar. Regular dinners - lots of beans, some pasta (rare-ish), steaks, potatoes, etc. We don't eat a lot of breads and not a lot of pastas and we eat rice more than pastas. We count carbs scientifically - meaning down to the last carb as best we can.

I would like to attribute our lower A1cs to the fact that we currently have our basals almost perfectly adjusted. This weekend our son was too preoccupied with playing with his friends to eat. He didn't eat until dinner at 6:00 PM. Bgs were flat from midnight until 6:00 PM with the exception of a slight low at noon and a glucose tab took care of that.

I honestly believe that getting the basals perfectly adjusted is critical to overall BG fluctuations. We've been out of adjustment and we roller coaster all day and all night. When we nail the basals we see flatter bgs.

I'm not sure if we've broken the puberty barrier so ask me again in a year and laugh at me if I'm terribly wrong.

In full disclosure we treat for 50s, 60s and 70s pretty often. I would say they are commonplace - not every day but they do happen pretty regularly and we just treat them and move on. No big deal. Also, almost never at night. Nights are almost always either flat or getting bgs down.

So, no price IMO.

 

Basically same post. She's a 14 year old teenage girl..yeah carbs aren't limited LOL! pizza, ice cream, milk and cookies you name it she eats it. She does marching band, and while some don't consider that a sport. It is very active practices ranging anywhere from 1-5 hours at a time (marching while carrying a baritone) If you don't know a baritone is a large brass instrument (similar to a tuba). I had no idea what a baritone was, when she first started playing. She spends nights at her friends all the time. Actually most sleepovers are at friends, rather than here. She doesn't want her 3 younger sisters bugging her and her friends. She does her own care while at friends (i used to text her at night to check BS, but she has started setting her phone alarm and checking herself at night) the only time i really hear from her is if she has a question on how many carbs something is (and of course i call her right before i go to bed to say goodnight). Basals are pretty perfectly adjusted here too. Currently she has 10 basals running on her pump. I go through her numbers and adjust weekly (basals, I:C ratios, and/or ISF)