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Highest A1C since diagnosis!

Discussion in 'Parents of Children with Type 1' started by mischloss, Nov 24, 2008.

  1. mischloss

    mischloss Approved members

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    This is just depressing. My son went up a whole point on his A1C this time around. From 7.1 to 8.1. Not a good "kodak moment" with the endo. :(

    All we can figure is that he has been skateboarding with his buddies a lot and not paying attention to stopping play and checking his bg consistantly. A few times he would come home from skateboarding and his number were past 250! He would tell me he just jugged a Gatorade cause he felt low. Did he check before? No, Did he bolus some for it afterwards, No!

    Doc is saying if he doesn't buck up, she will take away his pump and put him back on shots. That cleared his head quickly! He hung his head and promised to do better. Sigh! Of course as the Mom I feel all the guilt!
    Teenage boys! Gotta love em!
     
  2. frizzyrazzy

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    I'm sorry for the a1c rise - it happens though. But your doctor suggesting takign away the pump - as if the pump is a reward for good bg's - is silly. I wish they would have given you strategies for dealing with his life, instead of just threatening him. A pump is a tool. Nothing more, nothing less. hugs.
     
  3. Caydens_Mommy

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    Don't feel to bad, we went to the dr last week as well and saw a rise in our
    A1C has risen too, from 7.3 to 8.3 Not sure what is behind that other then maybe the pump start.. I know it is aggravationg, but we are doing the best we can.. :)
     
  4. Kalebsmom

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    Kaleb's also went up a few weeks ago. He was 6.2 and jumped to 7.3. His endo did not threaten to not let him pump but she did tell him how important it is to make sure he is checking. I think once he saw the number he realized how much he needs to do to get it better.

    He is 16 and I still take it like I did something wrong.

    It will get better.
     
  5. Andrews mom

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    I agree- it happens. An A1C can vary by ALOT of things. If you would have had a few lows in there it would have brought it down. Maybe he doesnt have any lows which is a good thing.
    Try again next time, its hard and my sons fluxuates all the time. Sometimes its in the 6's and other times in the 7's. Growth periods or holidays or different activity can make the A1C number change a lot. It'll get better (and worse at times) but I also agree that the pump isnt a reward, its just another way of delivering insulin. He could rebel and not do shots then it would get worse.
    Best wishes
     
  6. Tonysmum

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    I totally agree with Michelle. Using the pump as a bargaining tool is is a no go area with me. My husband once tried to tell my son that he would take away his pump if he didn't improve his eating habits. He found out really quick that the kids pump use is not negotiable. It is a medically necessary device. It's like threatening to take away an inhaler from someone with asthma or to take away someones oxygen tank. I would not expect a doctor to even try this tactic either, I would be looking for a new doctor with better negotiating skills.

    Good luck with getting him back on track. Maybe you could take over for a while until picks up?
     
  7. fredntan2

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    I'm glad my endo doesn't make a big deal about a1c's. If its good she will say it out loud, if not then she whispers it to me.
    I really don't think 8.1 is that bad.I'd be very very happy if we could get lower than 8.
    These teenage years will be the hardest I'll have to deal with.
    Ok so he didn't check before he felt low-but encourage him-you could say-Hey I know you didnt check, but thats great that you carried gator aid. And next tiem if he checks more positive reinforcement.
    I have a friend that has older dd-early 20's now. she said she couldn't get her lower than 10 her whole teenage years-and she's a nurse/father was type 1 also I think.

    Dont let these things get you down-It is not a report card. There will be better a1c's and there will be worse.
     
  8. maryellen816

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    Teenagers

    This may be an unpopular suggestion but valid for teenagers, I think. I do not make a big deal about my daughter treating a low without testing first when she is in certain situations out and about.

    Whether your son tests or not before treating a low, is not going to change his A1C. So I think the problem is not skipping the test. The problem is that he might be overtreating. If your son is drinking all of a regular gatorade and not bolusing for any of it you could either get him the lower carb gatorade or he should know that he has to bolus a little. That is what I would focus on - making sure he knows when and how much he has to bolus. That and trying to prevent the lows in the first place, of course.

    I agree with other posters - the pump is a tool, not some kind of reward for good behavior.

    Hopefully your doctor had some helpful suggestions and not just threats and warnings. Because an occaisional 250 on a skateboarding day does not make an A1C be 8.1. It is hours of being above 180.
     
  9. saxmaniac

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    I would say that a pump could be taken away, but only for really serious cases - like teens who refuse to take any insulin at all. At least with Lantus if you oversee the shot, you can get 24 hours out of it. This sounds like he's trying, but a normal bump in the road.
     
  10. zell828

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    Awww, I feel bad she threatened him to take the pump away :( I don't think that was the right thing to say.
     
  11. spamid

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    I think taking the pump away would be the WORST thing the doc could do, especially for a teenager. We are really struggling enough with my duaghter's numbers with hormones starting to kick in, without throwing in going back to shots. To us, 8.1 is not good, but not horrible.
     
  12. misscaitp

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    It's okay I've had my fair share of talks with the CDE, who handles all my care.

    I do the same thing during softball season with not being worried about my BGs, and just chugging down a bottle of gatorade. It does get annoying to have to stop everything and go check, so I ended up just correcting after I got home. This year I'm going to try to do somethings different, still need to plan with CDE.

    With taking the pump away, I feel that if she were going to take the pump away she came across in the wrong way. What she was doing was demanding or threatening for change. Compared to what my CDE told me, was "That we are going to give it a try for a couple of more weeks, and if I feel that you can achieve better control with MDI than we will have to switch to that." It's a big difference in the way it comes across to a teenager.

    But don't feel guilty, there will be more A1Cs to come.
     
  13. mischloss

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    Hi all thanks for the feedback.

    The pump threat came when I mentioned that he has been forgetful about bolusing for his meals. He gets up from the table and begins to do something and then I ask him, did you bolus and he can't remember and checks the pump history and then realizes that he didn't. He is catching the bolusing part too late with the pump. One time he completely forgot to bolus for breakfast and called me from the school clinic that he was over 400 and with moderate ketones! :eek: I think that is when he realized that he did something real stupid and felt lousy all day because of it. I mentioned to the doctor that when we were doing shots, there was no issue about "forgeting" to take the shot since it was right there next to him ready to go when he got done with the meal. Somehow the visual of the needle is a lot stronger then remembering to take a pump out of a pocket and push some buttons. My son't excuse also was that he can't bolus before a meal because he doesn't know how much he is going to be eating. The doc suggested that he bolus for at least half of the meal right up front and then compensate for the rest after the meal as needed. My son seemed to nod in agreement that that was a good idea.

    I also agree with the other poster that as a parent, having the Latus working in the background for 24 hours guaranteed in a way that numbers were not going out of control. Seems that skateboarding has some hazards of course where sites have come out and he doesn't get insulin for a couple of hours until he realizes. Things like that.

    She also came down on us for not filling in our chart with all the lunch numbers that are taken at school. I do ask the nurse to provide us a log sheet but it is not consistant. I usually scramble to get all the numbers into the log from a couple of meters and the lunch schools numbers during the last week before the endo appt.

    Now she wants me to fax int the log number to the office again weekly to make sure the numbers are being put into the log and she wants to have us back in 6 weeks rather than the 3 month appt. to retest I guess A1C and see how things are coming along.
     
  14. selketine

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    How did the shot get there? Did he set out the stuff before he ate or did you draw it up for him or ? I'm wondering if he remembered the shot before because you drew it up and handed it to him, etc. I am just thinking there might be a way to remind him to bolus - some pumps have alarms to set as reminders for things (to check bgl, to bolus, etc).

    I don't have a teenager yet so I don't feel qualified to comment on that aspect. I guess my sense is to praise him for what he's doing right and figure out how to fix what isn't working. I can imagine at this age they wish they could just go on with it and not worry about this stuff!:(
     
  15. mischloss

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    Hi Carol,

    Well, for the shots it would be collaborative effort. He had pen cartridges. So the cartridge with the pen tip already on would be taken out of the fridge and laid on the table next to him. He would then count his carbs and calculate the units (we would do this together just to be sure we were doing it right) and then he would administer the shot himself. Then get up from the table. I would undo the tip, toss the old tip and place the pen back into the fridge. During outings, we had a special blue small lunch bag to carry the pen cartridge in. His bg monitor would fit into the lunch bag snugly as well. When he would out with his friends he would take a frio bag with the pen cartridge or the same lunch bag (just depending on the activity) along with him. It was the bag that alerted the other kids to pay attention and remind my son to give his "shot." With the pump in his pocket I guess the kids don't really think about it and since it is out of sight, it quickly becomes out of mind.
     
  16. caspi

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    I'm sorry, but I think the doctor was out of line for saying that about the pump. There are a lot of variables that go into an A1C. You have a child that is going through puberty. My non-D is also 13 and is going through it right now big-time. I'm sure that's wreaking havoc on your son's #'s!

    To threaten to take away the pump is, IMO, wrong. Yes, he should be checking more often and this is something that you guys will work on.

    Also, an A1C isn't a report card, so please don't beat yourself up over it! It's just one of a number of things that gives us a bigger picture of our child's D. There will be good A1C's and not-as-good A1C's. These things happen.

    I also have to wonder if 6 weeks is enough time to change an A1C? I'm not sure - there are others on here with more experience with that.

    Big ((HUG)) to you, Mom! You are doing a GREAT job and have a very healthy, active teenager! Be thankful for that (which I know you are!) :cwds:
     
  17. mischloss

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    Thanks Caspi for the kind words.

    We really have a good relationship with this endo. She is very concerned for our son. She was one of the first to see him in the hospital when he was diagnosed and one of the endos in the group that DID endorse the pump for him. I think she might not have used the right words in the situation but I think her heart was in the right place.
     
  18. czardoust

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    Just wanted to chime in and say 8.1 isnt so bad. Kat lingered between 9-10.0 for 3 yrs before we broke thru that A1c wall. You can do everything right and still be reminded that your not in control 100%. Im sorry the endo told him that.
     
  19. frizzyrazzy

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    ok, that's a lot more info...that sounds reasonable.

    here's what doesn't sound reasonable. He's 13. he knows how much he can eat at a meal. Even my 8 year old can tell about how much he's going to eat for a first helping. If there's a question - just bolus for the first helping. Its on his plate. He's going to eat it. Bolus for it. Then make up the rest after meals. If nothing else, at least if he forgets the 'after' bolus he's already got a good bolus ahead.

    Prebolusing, even just sitting down to eat will give you an instant boost in the a1c.
     
  20. StillMamamia

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    How about making him responsible for logging? Like at home, you put up a sheet, he's obliged to test and log, and then to write down how much he's bolused.
    Prebolusing is also a good idea, I agree.
    Hang in there.
     

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