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Are young children "protected" from comlplications of hyperglycemia?

Discussion in 'Parents of Children with Type 1' started by Darryl, May 10, 2009.

  1. Lisa P.

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    Now, now,:cwds: once again I'll point out that this is NOT what my endo said. I can even sympathize with your fear that some parent may take it that way, but it is emphatically NOT what he said. That's a strawman argument, and those are never useful when really trying to get to the truth.



    How about if they said it like this, the older a kid gets the more important it is to bring the BG into a range closer to that of nondiabetics. Would that be palatable ?
     
  2. hawkeyegirl

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    But what is the point? I see on this board time and time again parents who have been told by the endo that you can run small children higher because high BG in young kids doesn't cause the same complications as is does in older kids and adults. Is it true or not? I think it's worth questioning this advice.

    What I suspect is that endos want to protect parents of small children from scary lows, and also underestimate the ability of parents to have decent BG control in small children. So the easy advice is, "Run them higher. It won't hurt them." I suspect that's totally false, and since our kids who were diagnosed young have that many more years of diabetes ahead of them, that these young years matter very much when it comes to complications. As the mother of a child who was diagnosed at age 3, it would be comforting to believe otherwise, but I just don't. :(
     
    Last edited: May 15, 2009
  3. moco89

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    In the Scandinavian countries, which have extremely high incidences of type 1 diabetes, there have been studies evaluating complications among type 1s there.

    They document almost everything in those countries, and there are national registries for certain diseases within those countries. I remember a long-term study that said children diagnosed under age 5 rarely get severe kidney disease later in life, which is somewhat ironic. I don't know what this can be attributed to.
     
  4. Darryl

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    Lisa,

    I was referring to a different post where (if I recall) an endo told a parent that young children could have some kind of regeneration, and were therefore OK with high BG's. I am not trying to put individual members on the spot. The comments that led me to start this thread have been posted by many people, in many prior posts, but the theme is the same... it's OK to run the youngest children at higher BG's because the BG's are not as damaging to the younger kids.

    What if the opposite was true? Wouldn't we want to know?

    About "the older a kid gets the more important it is to bring the BG into a range closer to that of nondiabetics",
    I'd be all for that if it was true. I just don't know if it is, and the DCCT says otherwise at least with respect to teenagers - it proved conclusively that the first 10 years of treatment is the most important.

    What I'd really like is some honesty from the endos: If they want A1C at 8% because it's the only possible way to avoid hypos, then they should say it that way, and not imply anything about studies unless those studies exist (and are valid randomized control studies as with the DCCT). And I hope that those studies DO exist, and would love to see them and admit that I am wrong!
     
  5. Darryl

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    Thanks Monica - I would love to see the study if you can locate it!
     
  6. Seans Mom

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    The person (referring to the "regenerate" comment) was on another board and I was the one trying to remember what it was she said her sons' endo told her about the cells of young children.
    In other words.......
    1. You will not get a quote from her endo since she is not on this board. and
    2. I probably, no make that, I'm sure I don't remember it quite right. But it was about there not being as much danger to the younger childrens body running the numbers higher (not chronically high like you suggest) then to let them run too low.

    It seems to me that you've purposely misquoted some main words in your quest for an answer. I don't remember anyone suggesting chronic highs were not damaging to young children or anyone else. Also, higher numbers doesn't necessarily mean 180 or above, where sugar is spilling over. ;)
    I think it's great you and your daughter can keep her numbers in such a tight range but it is much different in a child her age, one who can tell how she feels with her numbers and manage her own care and the little ones who can't even tell that anything is off.
    My son can and has been 32 and 34 and going about his day as usual. When asked how he felt... he says "fine". Same thing if he's high.
     
    Last edited: May 15, 2009
  7. moco89

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    Found it, but right now, I only have the abstract. http://care.diabetesjournals.org/cgi/content/abstract/29/3/538

    This was a study involving over 12,000 type 1 patients.

    "A significant difference in the risk of developing ESRD was also found between children with prepubertal (0–4 and 5–9 years, n = 2,424) and pubertal (10–14 years, n = 2000) onset of diabetes (P = 0.002). No patient with onset of diabetes before 5 years of age had developed ESRD."

    I'm not saying anyone is immune to kidney disease, but you get the idea here.
     
    Last edited: May 15, 2009
  8. dqmomof3

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    Our endo is one who believes A1C values in children should never be below 7%. She doesn't quote a study, per se, for why she believes that. She counters, when I dispute that number, that there is no glucometer on the market which can guarantee complete accuracy, and that as we all know, meters can be plus or minus twenty percent and still be considered "accurate." In her opinion, it is unsatisfactory to try to run a child's blood glucose at 80 all the time, because you don't really know if that 80 is an 80 or a 64 (or of course a 96).

    She says there is no reason to take a chance with children whose brains are still growing and require glucose for fuel.
     
  9. hawkeyegirl

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    The problem with her line of thinking is that you don't have to be running your child at 80 all the time to get an A1c in the 6s. Heck, our last A1c was 6.6, and I think that is equivalent to an average BG of 150 or so. I also believe that our meter is much more accurate than the required 20%. (I know you're not necessarily agreeing with your endo - I'm just pointing out a flaw in her thinking.)

    I think running them high is a bigger risk than occasional mild or even moderate lows, but that's just my opinion. :cwds:
     
  10. Nancy in VA

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    Running them higher is not a bigger risk. A single low can cause unconsciousness and seizure. It takes prolonged highs before the risks are higher. When a child in unaware or unable to express how they are feeling, the risks to lows are significantly greater.
     
  11. tom_ethansdad

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    Interesting as our last visit we were told different. Ethan is 3 and dx less than a month ago. At dx his A1c was 10.3. We were told that ideally they would like to get that below 8, and below 7 would be even better but that is hard to do in young children. So she's not saying that below 7 is bad, in fact it's desired, just that it's hard in the younger ones. She's saying a more realistic target is 8.

    I don't know what the answer is, but I do agree that if there are claims that younger ones better tolerate higher BG numbers then I would like to see the studies to support that. But that's just how I am. Not that I don't trust what people tell me, just that I like to see the details behind what I'm being told.
     
  12. Nightowl

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    I am trying to figure out what could possibly be the motivation for a comment like this. I can't imagine any parent of a type 1 diabetic child not being interested in this question. You could have easily skipped over this thread if it held no particular charm for you, but to so rudely dismiss it I think reveals that there is something about this question that you find personally uncomfortable.
     
  13. hawkeyegirl

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    In my post I did say that I think running them high is riskier than mild or moderate lows, neither of which would cause unconsciousness or seizures. Certainly severe lows are to be avoided at all costs, but just because the risk of them is more immediate, I don't know that the overall DAMAGE caused by them is any greater than the damage caused by an A1c in the 8s or higher.

    Really, as long as the parent is doing their best to achieve low BGs without having serious lows, that's all they can do. But I do worry that some parents hear that an 8 A1c is "just fine" and don't really work very hard at getting it lower. If you can get it lower without severe lows, I can't imagine why that's not a good thing.

    ETA: This is, of course, my opinion. I'm not an endo, and it doesn't appear that there are any studies on this. What I do know is that lifetime A1c is STRONGLY correlated with complications, and I believe every day counts. Lord knows it would be a heck of a lot easier to run Jack higher and get some damn sleep sometime. :cwds: I kill myself for his A1c, and it is worth every minute.
     
    Last edited: May 15, 2009
  14. Darryl

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    Monica, that is a good study - thank you! I assume ESRD means the worst possible outcome? Does the full text article speak to more typical/partial nephropathy, that which affects a broader population?

    At the bottom of the same web page are links to two other studies that imply that children under the age of 10 may have delay onset of complications:

    From this study:
    http://care.diabetesjournals.org/cgi/content/full/30/9/2338

    The cumulative incidence of blindness and RRT during follow-up was significantly higher in the pubertal-onset group than that in the prepubertal-onset group (Fig. 1A). However, analysis by whether the subject attained 18 years of age demonstrated no significant difference in cumulative incidence between these complications, regardless of age at onset (Fig. 1B).
    This study does conclude that complications may be delayed for children dx'd before puberty, and explain that this is likely due to the fact that BG control is most difficult during puberty. This would reinforce the DCCT's conclusion that the first 10 years of BG control matter the most, regardless of when those 10 years may fall. Regardless, both studies conclude that by age 18, the complications were equally prevalent regardless of age of onset.
     
  15. Darryl

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    Barb,

    The exact phrase I was quoting was
    "the endo stated something along the lines of cell regeneration in the young protect them from the damages of higher numbers"

    I know this was not you opinion, or your endo's opinion, you were just mentioning that someone else's endo posted that on another board. Regardless of whose endo said it, I was quoting what was written pretty accurately as far as I can see. I'm not sure what you think I've misquoted.

    My intent is only to get the research out for people to see, and I am more than happy to see research that would support regerenation, or anything else that would imply that a higher A1C is safe.
     
  16. Reese'sMom

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    This sums up my personal thinking as well. Every child is different, every situation is different, but if on average you can keep a child in a tight range without severe lows...then this has got to be good for their health long-term. If trying for a lower avg. bg yields severe lows, then it is not worth the risk.
     
  17. Jacob'sDad

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    OK, I'm afraid someone is going to ask this question so I'll just do it.

    So an endo says to parents of newly dx'd type 1 kids, "Look this is the way it is. The only 'perfect' A1c is a non diabetic normal A1c. The higher the A1c is the greater the risk of complications and that is true no matter the age of the person."

    So the parents of one child recently dx'd really take his statements to heart and set a very low BG target. But they are new to this and early on their child has a VERY bad low and something VERY BAD happens to their child as a result.

    Can they sue for malpractice? Is that what endos are afraid of (malpractice and something BAD happening)? And if so, can you blame them?
     
  18. Darryl

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    When we left the hospital with NPH, Humalog, and a blood test meter, the severe low's (and severe highs) started the day we got home, and continued until 4 months later when we got our pump and CGM.

    As I mentioned earlier, the question is not as black and white as "high A1C vs. coma or seizures". If an Endo simply prescribes a higher A1C, without regard to current techniques, pumps, CGM's, and various insulins that (and the all-important tech support) then they have overlooked the fact that there is a 3rd possibility: good BG control.
     
  19. Reese'sMom

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    I'm not sure that I think this is directly what they are thinking of but I will say this: I do believe that Drs. want to ensure good care NOW...and avoid problems NOW...and they are not always concerned about 5-10-20 years from now as much as we are.

    I say this because in pediatric cancer, all of the statistics are based on a 5-year survival rate, not what happens to the children in 10-15-20-40 years...it is only very recently that they have begun tracking all of the health problems the survivors face from the toxicity of the treatment known collectively as the "late effects" and they are significant.

    Pediatric Endos may have a little bit of the same myopathy, I am afraid. They don't deal with the "late effects" much...and in a very subtle way, they MAY not(this is totally my personal theory with no studies whatsoever to back me up!:eek:) be as focused on the long-term issues (complications) as much as the short-term issues (severe lows). JMO.

    Edited to add: Also, since we are talking about studies...are there any studies that show the lack of brain development that has been caused when younger children have been given lower target bgs? Is this also just a theory, or is there some evidence to support this line of thinking?
     
  20. Darryl

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    I agree.

    FYI, the statute of limitations for medical malpractice is 2 years.

    Complications rarely arise within 2 years, but hypo's do.
     

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