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Have some LOWS for a better A1C?

Discussion in 'Parents of Children with Type 1' started by BrokenPancreas, Apr 27, 2011.

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  1. BKKT10

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    I was told by our endo at our first visit "when you aim for perfection, lows are inevitable." He did not advocate lows, he just pretty much let us know that we should expect them and not to beat ourselves up.

    If your CDE/Endo gave you a target range, you should be aiming for that - not aiming for something lower.
     
  2. hawkeyegirl

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    Respectfully, both you and Manda have missed the point entirely. You are both misunderstanding in the same way. Since about 15 people in this thread have explained to you what the CDE likely meant and you still aren't getting it, I'm more convinced than ever that you completely misunderstood what the CDE was trying to say.

    Let me try again.

    Your CDE was basically saying that your settings are set to run your child too high if you aren't seeing the occasional low in the 50s or 60. Your CDE was NOT saying that you should intentionally cause lows or that you should run your child in the 50s or 60s. I don't know how to say it any differently. The improvement in A1c would not come from the occasional 50 or 60. It would come from your child being in the 70s, 80s and 90s more often.
     
    Last edited: Apr 28, 2011
  3. Nancy in VA

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    I'm with those that think maybe you didn't quite take it the right way.

    If you are running an 8, then he is running too high. If you are treating lows in the 80s, you need to stop.

    I don't treat lows in the 70s.

    I treat lows in the 60s with just a tablet - it takes something in the 50s before more carbs come out.

    There is no reason for a target of 130 with a CGMS. My goal is closer to 100 - 110 when Emma is wearing her CGMS (she's been off it for about 3 weeks just becuase and we have HAD more lows than normal but still only a rare really low one - the rest have been in the 60s and that is a "treat small and move on")
     
  4. Melissata

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    I agree with Karla and Nancy, especially when using a CGM. They used to believe that brain damage was possible from too many mild lows, but a Joslin study a few years back disproved that. I also want to point out that for most people and especially kids, the 15 carbs to treat a mild low is the reason for the spiking. That is just way too many carbs most of the time, and starts the roller coaster ride of bg's. I am not a Bernstein follower by any stretch, but that was one thing that I learned from reading his book, and that was worth many times the price of the book! Having such high targets with a CGM that you trust just doesn't make sense to me either. I really think that a lot of parents are so afraid of lows that they are running the kids far higher than they should be. Of course if you have a child that has seizures with lows, none of this applies.
     
  5. manda81

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    I'm sorry. I didn't realize the question was based on what the CDE "meant". The OP asked a question about running their child low to lower the A1C. I answered that question specifically. I have no way of knowing what the CDE meant by their statement.

    This line specifically, is what I am referring to. If that is what the CDE said, IMO they are wrong. Aiming for a low every day is horrible advice to give someone. Lows are not the goal, and never should be.

    I do agree though, that running them with a target of 90s would occasionally give you more lows, but those lows aren't intentional, which is how I read the question to be asked.
     
  6. hawkeyegirl

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    Since a low a day in itself would likely have almost no "dramatic" impact on an A1c, I don't think there's much doubt what the CDE meant. Put another way, there are two possible interpretations for what the CDE said. One possible interpretation is that you should intentionally cause at least one low a day, and that will lower your A1c in a significant way. Since that's both factually wrong AND dangerous AND absurd, I'm guessing that what she meant was exactly this:

    Which is completely reasonable, and a philosophy shared by many parents on this board.
     
  7. PixieStix

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    Aiming for a lower and tighter BG range will invariably lead to more lows. Our endo asks at each appt how many times/week does DS have a low that is symptomatic such that he needs assistance--does happen sometimes, honestly usually when I have overridden the bolus wizard trying to budge a stubborn high. With the CGM most lows are cut off as the BG falls, try to use 1-2 sugar tabs so as not to overtreat and rollercoaster back up to a high.

    Each family has to do what they are comfortable with. For me, I really don't see the DCCT results as totally obsolete...we know what happens when BGs run high--it's a balancing act of dangers today/dangers tomorrow. So while not aiming for a low a day, I do aim for 70-100, accept random lows, and aim to keep the highs lower and shorter in duration.

    Agree w/ others the A1C of 8 would indicate BGs running higher, don't need a "low a day" but would have been ideal for CDE to address BG target range perhaps.
     
  8. mmgirls

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    With tighter control you are going to get some lows, sometimes multiple times daily.

    Some people consider anything under 80 to be low, but I am perfectly fine with letting her hang out in the upper 60's to 70's whenever I can, of course that means when she is with me. Of course that means that if all of a sudden she is going to be outside and playing, or want t play on the Wii then I will need to get some fast carbs into her to have wiggle room.


    I also will immediatly bolus for any additional carbs consumed while treating a low, using the CGM info really does help with this.
     
  9. badshoe

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    This is our experience as well.

    I explicitly, cause I asked, understand it to mean that trying for good control, in range, will a few times a week result in mild lows that need treating because YDMV.
     
  10. Christopher

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    I guess it also depends on how often you check at night. I check often. For example, last night Danielle was 88 at bedtime, and I left it, knowing I would be checking her soon. Next check she was 92, left it. Next check she was 84, and I left it. I could have given her some carbs to make her go high and then I could have gone to sleep, but I would rather keep her in range. Or try to.

    As for correcting a 200 at night, I do that and I don't worry about her going low because I am checking her at night and I will catch the low. I don't feel comfortable letting her be that high just so I can sleep.

    Everyone has their own management style.
     
  11. Christopher

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    Wow. :confused:

    I was simply sharing my experiences.
     
  12. wilf

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    It's 2 years after your child's diagnosis - many families around this time start to make their own decisions around treating and correcting and bolusing. Just because your endos have told you to do or not to do something, doesn't mean you have to obey them. :eek:

    I think if you've been told not to correct at night then you've been given advice that may have made sense at one point (when you were a newbie) but it probably doesn't now, given the A1C.

    I think it is time for you to do some reading and learning, so that you can manage the D more confidently and independently. :cwds:
     
  13. hawkeyegirl

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    Well, my endo told me that I didn't have to check BG at night. :rolleyes:

    The moral of the story is that endos are not always right. I love our endo, but I know more about managing my child than he does. Part of the reason why I love him is that he would admit that too.

    If you are happy with the advice that you're getting from your endo that is leading to your daughter's A1c, there is no reason to listen to any advice in this thread. If you are not, I'd step away from the thread for a few days and then come back to it when you aren't quite as mad and see if there's anything useful that you can take away from it. Every last person is just trying to help. :cwds:
     
  14. Darryl

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    I've read this thread 3 times and I can't figure out whose daughter you are talking about :confused:

    Anyway -

    If an endo tells you to not correct at night, they are taking the easy way out... subjecting the patient to prolonged, damaging blood sugar levels that could be easily and safely corrected if the proper techniques are used. The statute of limitations for medical malpractice typically 2 years. Long term complications take 3 to 5 years to develop. Do the math and you will understand where the endo is coming from.

    If an endo really cares, they will talk to you about ways to enable you to correct safely overnight (at least in some cases, and every bit helps). This could include more frequent testing (as Christopher mentioned), or use of a CGM. It is in your hands to make the decision.

    As to the OP question, if you strive for a lower average BG you will have more lows. As long as these lows are mild, you are better off with mild lows than sustained highs.
     
  15. Flutterby

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    I agree with others. I think you miss understood the cde. If you think that she ment for you to purposely have your child go low once a day, and the endo is telling you to leave her at 200 and not correct at night then this needs to be addressed within the office. The CDE and endo should be on the same page, they clearly are not.

    The tighter control the more likely you'll have 'lows'.. personally, I would like Kaylee to be 70/80 before a meal, 70 is considered 'low'.. 70 is a 'normal' bg for a non-diabetic, there is no reason why a child (especially an older one, I'd be much more cautious with younger kids, toddlers/babies--I definitely was when my child was younger) can't be 70/80 before a meal/snack.

    We were told things at the beginning that make no sense to do now, like post bolusing, correcting no more than every 3 hours, waiting until she was 450 to correct (yes, her correction factor was that HIGH and that was .25u and STILL sent her low (40s), having a range of 180 during the day and 250 at night.. These aren't things that we do now, over time these things have slowly changed, especially when we went to pumping. There is absolutely no reason to not correct a 200 at night while on a pump. If the regular correction factor is to strong, you can set a different one for night, or mannually change it, there are also temp basals that aren't available while on MDI.

    If the CDE and Endo are sending mix signals its time to ask some serious question. Ask them WHY you they don't want you correcting at night, as the CDE what she ment by daily 'lows'.. They work for you, you deserve answers. There also comes a point where YOU are making all the decision, or that is what the office should be working towards, if they aren't, maybe its time to search out a new endo. We were told from day 1 that WE will be managing her dosages/changing/correction etc, they will work with us to get us comfortable.. Of course they are there if we need help but they don't make daily decisions, and haven't for a long time.

    They surely can download the pump, and see everything you've done, but really, that shouldn't scare you into doing a correction or doing things that you think will work better for your child.

    No CDE/Endo would tell you to intenitionally send you child low to achieve a better A1c, you need to ask for her definition of 'low' and what she ment by that, and if she truely did mean for you to send your child low once a day then you need to find a new endo and cde.
     
    Last edited: Apr 28, 2011
  16. Sarah Maddie's Mom

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    You can feel defensive and get all snarky, or you can listen to the collective experience and maybe, just maybe, rethink how you are listening to your CDE. No one here called you stupid, but many folks have suggested that we can't take a CDE's advice to heart if it seems to be working against your kid. It seems that you are taking your CDE's advice literally, but as Badshoe has taught us, "YDMV" and your kid's D may not be the D your CDE is assessing.
     
    Last edited: Apr 28, 2011
  17. NomadIvy

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    Not to derail the thread...but can someone please explain this to my dh... :p

    Edit to add: just read through the whole thread and I agree with the advice most people gave. I really don't understand how endos would allow anyone to be "soaring" at night. If we can keep them in range at night, half the day is solved. Our first endo in Japan wanted me to keep her at 200 so I could sleep. Umm...no thanks, I'd rather be up checking than to think of what damage those high BGs are doing to her body. Our current endo there doesn't like seeing anything higher than a 7% (love him for that but he doesn't know much about pumping). Yep, step back, breathe, relax, read again. I think everyone answered with respect and concern.
     
    Last edited: Apr 29, 2011
  18. StillMamamia

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    Ok, I think there are 2 issues here. The first is your CDE suggesting to let some lows happen to lower the A1c. I think what may have been implied, through a bad choice of words (IMO) is that lows can happen, but not that one should aim for lows, kwim? There's a difference, as others pointed out.

    The second issue is the A1c of 8. Ok, so you have the CGMS and you have a range to aim for. My question is what is happening overnight? Perhaps that is the key to lowering the A1c in this case:confused: Perhaps different testing times overnight as well?

    Just wanted to mention sneaking of food. Do you think this could be happening?

    Prebolusing? I'm sure you're doing this already, but is the advance time enough? Are you also checking at 2hrs pp, and if higher than the desired BG for the 2hrs pp, are you correcting?

    Regardless of what the CDE said and what he/she meant by it, the real issue is that you want to lower the A1c, right? So, I think there's excellent advice already given. An external pair of eyes is always good to see what we don't. Sometimes the forest looks like a pine forest and, to another observer, they'll find an oak-tree in there somewhere. Don't hesitate to post your BGs and get feedback. Just a suggestion.
     
  19. BrokenPancreas

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    The second issue is the A1c of 8. Ok, so you have the CGMS and you have a range to aim for. My question is what is happening overnight? Perhaps that is the key to lowering the A1c in this case:confused: Perhaps different testing times overnight as well

    What happens overnight? What does that have to do with her blood sugar?
    This is really a personal question, kwim?


    Just wanted to mention sneaking of food. Do you think this could be happening?

    Hmmmm.. Her A1C is an 8, which means her average is in the 170's... I don't let he go low on purpsose, (see Barb's thread) but you know what, in the past month, there has been three brontosauraus burgers GONE.. They just vanished from the fridge. I wonder,, now I'm really wondering if you're right



    Regardless of what the CDE said and what he/she meant by it, the real issue is that you want to lower the A1c, right? So, I think there's excellent advice already given. An external pair of eyes is always good to see what we don't. Sometimes the forest looks like a pine forest and, to another observer, they'll find an oak-tree in there somewhere. Don't hesitate to post your BGs and get feedback. Just a suggestion.[/QUOTE]

    I don't get this, I'm extremely allergic to oak trees?:confused:



    Don't hesitate to post your BGs and get feedback. Just a suggestion.[/QUOTE][/B]

    Thank you for your suggestion.. Why would I post my BG's? It's my daughter with the horrible 8 A1c? But, if you think that could help, I certainly could start logging my own BG's. Thanks....
     
  20. hawkeyegirl

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    Okay. We get it. You're fine with your daughter's A1c. No one on here could have any advice that might be useful. We get it. But Paula didn't deserve this. :(
     
    Last edited: Apr 29, 2011
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