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I have 7 kids and 6 of there A1c's are over 6.0

Discussion in 'General Discussion' started by mom2seven, Jan 6, 2007.

  1. mom2seven

    mom2seven Approved members

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    I have 7 kids ages 2-9 and I was worried about my kids having some random BG over 200 so had there A1c's done and they came in at, Oldest to youngest, 6.1, 6.2, 5.8, 6.6, 6.3, 6.8, 6.6! The Dr wasn't in Friday and will call us back on Monday. What in the world would you think if 6 out of 7 kids had A1c's over 6.0?

    A little history, I have pre-diabetes (my number seem to be in the diabetic range now) and my last A1c was 6.4 and no other family history of diabetes.
     
  2. BrendaK

    BrendaK Neonatal Diabetes Registry

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    Do any of them have symptoms of diabetes -- increased thirst, urination, blurry vision? Some of those A1C numbers seem high to me, but they are not in the alarmingly high range -- 10 or 11%...

    Definitely discuss this with the doctor Monday. But if any of you kids have severe symptoms of diabetes, head to the ER right away!
     
  3. MrsBadshoe

    MrsBadshoe Super Moderator

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    Hey again Julie....

    Fancy meeting you here.....

    Good Luck on Monday with your dr.

    Kimball
     
  4. mom2seven

    mom2seven Approved members

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    Thanks BrendaK, We do have increased thirst, urination that comes and goes and one that is wetting the bed after staying dry for 4-5 years. None of my kids are overweight, all are thin some too thin.
     
  5. Ellen

    Ellen Senior Member

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    What was the lab range for normal at the lab that ran the tests?
     
  6. mom2seven

    mom2seven Approved members

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    Hi MrsBadshoe, Thank you.
     
  7. mom2seven

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    Last edited: Jan 6, 2007
  8. Ellen

    Ellen Senior Member

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    Certainly I would want a ped endo to follow any child who has symptoms of diabetes.

    Rick Mendosa's site states "For the A1cNow system the expected normal range is 3.9 percent to 6.5 percent" http://www.mendosa.com/homeA1c.htm

    I would question the accuracy of this device to measure A1C in your otherwise healthy 7 children, and urge you to write to the doctor at Shands listed below in the second abstract and ask that researcher's opinion. ( kenneal@medicine.ufl.edu) It would be an enormously unusual event for 6 out of 7 of your children to be converting to type 1 diabetes at the same time, but the doctors and researchers at Univ. of Florida at Shands http://www.medicine.ufl.edu/endocrin/endo_faculty.asp are top drawer.

    Who actually performed the tests and used the the individual kits? I believe there can be user error with it too although the first abstract below refutes that theory.

    Most important, are you certain the A1C Now kits had not expired?

    Here are some pieces of information:

    http://web.missouri.edu/~diabetes/ngsp/CAP/CAP06b.pdf (-- I don't understand this document - can someone please explain why the %CV is so much higher with the "Metrika A1C Now" than the "Bayer DCA 2000" that my son's ped endo uses?) Someone was kind enough to send me this explanation of coefficient of variance.) http://www.swrp.org/Student_Presentations/preparation/Poster/Statistics/coeff_variance.html

    Two abstracts:

    Clinical Evaluation of a Rapid A1C Test (A1cNow) for Home Use.
    Original Articles
    Point of Care: The Journal of Near-Patient Testing & Technology. 5(3):116-120, September 2006.
    Klonoff, David C. MD *; Bergenstal, Richard M. MD +; Cole, Thomas G. PhD ++; Bohannon, Nancy J.V. MD ; Ammirati, Erika B. BS [//]; Blatt, Joel M. PhD [P]; Irvin, Benjamin R. PhD [P]; Stivers, Carole R. PhD [P]; Clark, Annette L. BS [P]

    Abstract:
    Introduction: A1C can be measured by portable point-of-care methods that might offer advantages compared with conventional sampling of venous blood for eventual laboratory testing.
    Methods: In a 2-part study, we compared the performance and ease of use of A1C measurement with a single-use, disposable A1C test (A1cNow) and a venous sample measured by a reference laboratory. Part 1: At 3 sites, 297 untrained subjects self-tested with an A1cNow. Trained medical professionals performed a second A1cNow test on each subject. Venous blood was sent to a National Glycohemoglobin Standardization Program Secondary Reference Laboratory for A1C testing. Untrained and professional A1cNow test results were compared with the reference results and with each other. A quiz and questionnaire evaluated, respectively, subject comprehension of A1cNow's product labeling and opinions on ease of use. Part 2: At a fourth site, trained medical professionals performed an A1cNow test on 30 subjects. Venous blood was sent to the same reference laboratory. Professional A1cNow test results were compared with reference results. The professionals recorded the amounts of time needed for A1cNow testing and reference laboratory testing.
    Results: Part 1: For untrained A1cNow versus reference, the slope and y intercept were 0.988 and 0.168, respectively, with r = 0.93 (paired Student t test, P = 0.50). For professional A1cNow versus reference, the slope and y intercept were 0.965 and 0.400, respectively, with r = 0.94 (paired Student t test, P = 0.21). For untrained versus professional A1cNow, with Deming regression, the slope and y intercept were 0.972 and 0.269, respectively, with r = 0.88 (paired Student t test, P = 0.58). Overwhelmingly, subjects responded correctly to quiz questions and favorably to opinion questions about the product's ease of use. Part 2: For professional A1cNow versus reference, the slope and intercept were 0.9504 and +0.28, respectively, with r = 0.95 (paired Student t test, P = 0.85).
    Conclusions: Untrained users can operate the A1cNow test with good performance equivalent to that obtained by trained medical professional users. (C) 2006 Lippincott Williams & Wilkins, Inc.

    1: Diabetes Technol Ther. 2005 Dec;7(6):907-12.[​IMG] Links
    Comment in: Diabetes Technol Ther. 2005 Dec;7(6):913-5. Glycated hemoglobin assessment in clinical practice: comparison of the A1cNow point-of-care device with central laboratory testing (GOAL A1C Study).
    Division of Endocrinology, Department of Medicine, Shands Hospital at University of Florida, Gainesville, Florida 32610, USA. kenneal@medicine.ufl.edu
    BACKGROUND: The Glycemic Optimization with Algorithms and Labs At Po1nt of Care (GOAL A1C) Study assessed the effect of titration monitoring strategies and methods of A1C testing on glycemic control in patients with type 2 diabetes failing oral therapy and beginning basal insulin glargine. The availability of both point-of-care (POC) and central laboratory A1C values provided an opportunity to evaluate correlation and statistical agreement between these methods of testing. This analysis forms the basis of the current report. METHODS: This is a 24-week, randomized, four-arm, open-label study conducted in 7,758 subjects enrolled at 2,130 sites. At baseline, patients had A1C measurements both by POC testing using the A1cNow device (Metrika, Inc., Sunnyvale, CA), which applies an immunoassay method, and by central laboratory analysis using ion exchange high-performance liquid chromatography. These measures were compared statistically. RESULTS: An r value of 0.72 was calculated for POC and laboratory A1C assessments. Although the mean POC A1C values were in agreement with the central laboratory values, there was a large range in individual POC A1C values. CONCLUSIONS: POC testing of A1C in predominantly primary care settings using the A1cNow device was correlated with central laboratory results. The correlation was less than expected based on each method's reproducibility data. Although there was agreement between the average POC A1C values and the corresponding central laboratory values, the dispersion of individual POC A1C values was large. Thus, we conclude that these two methods of A1C testing should not be used interchangeably.
    PMID: 16386096 [PubMed - indexed for MEDLINE]
     
    Last edited: Jan 6, 2007
  9. JasonJayhawk

    JasonJayhawk Approved members

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    Hi mom2seven,

    Ellen says it best. First, you must consider the reference range. I still cringe when I see someone mention their A1c value, but fail to mention the lab's "normal" range. For example, "Hi everyone, my most recent A1c was 5.4% (ref range < 6.0%)." Each lab has their own normal range, and therefore, comparing someone's 6.4% A1c with a 6.0% A1c is like comparing apples to oranges if the reference ranges are different.

    In the "old days", I remember when people even reported the lab and location where the test was done. For example, "Hi everyone, my most recent A1c was x.x% (Quest Diagnostics, St. Louis)". This was before "normal ranges" were established.

    Work is being done to standardize the values, but it is not yet complete.

    Those home A1c test meters are not cheap... you must have spent at least $100 on them. Does your insurance cover lab tests? Home tests usually aren't "admissible evidence" for a doctor, so be prepared to have more blood draws done.

    If your kids were over their standard weight for their heights and ages, there would be greater cause for Type 2 concern.

    Don't be too alarmed. It's easy to self-diagnose with the limited information on the internet. I'm sure your PCP will be able to put you at ease.
     
  10. mom2seven

    mom2seven Approved members

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    UPDATE, Still haven't talk with the Dr. We have called and left messages ever day, sometime 2 times and still no call back.

    I'll post when I hear from her.

    Julie
     
  11. mom2seven

    mom2seven Approved members

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    DH talked with the Dr, This is going to be a fun ride, NOT.

    Dr said that the A1c told her nothing, that the normal range would depend on EVERYTHING, humidity, temperate in our house, bah, bah, bah. That there would NOT be a normal range for a home test. Than she said that a child's glucose could be ANYTHING at anytime, WHAT. She said for it to being over 200 was OK for a child. Dr said to bring in the child that had the highest A1c to do a new A1c (no fasting and GT yet), the highest was 6.8 and was the 3 1/2 year old. If Dr says the child is OK than DH will never listen to me again (he said this).
     
  12. Aprilsmom

    Aprilsmom Approved members

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    You need to find a different doctor and fast. The aic's may be ok, but some of the symptoms definately need to be checked out, but not by this doctor. My daughter goes to one of the best doctors that there is, and these standards you are speaking of do not even come close or could compare to what is considered somewhat standard. Please seek the advice of someone else. Is this doc an endo?
     
  13. sheila

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    :eek: :eek: :eek: :eek:

    I would be finding a new doctor, pronto.
     
  14. AmyMcCracken

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    Mom 2 Seven - you need to see someone different. Even though an A1C isn't the best indicator you should do further testing. I say that because of my experiences. My 4 year old daughter was having horrible mood swings, occassional bed wetting and wasn't acting normal. My brother in law is Type 1 so my husband & I both suspected Diabetes. I took my daughter to the doctor in August 04 and asked that she be checked for diabetes. They did a blood glucose test and checked her urine for ketones. The ketones were negative and her blood sugar was 131. I asked the daughter about doing a glucose tolerance test and she said it wasn't necessary. After 3 months of HELL my daughter was admitted to ER in DKA. The glucose meter read HI (over 600). This doctor totally missed the diagnosis even we asked her for more tests. We don't know the long term damage that was done.

    My daughters symptoms started with:
    Mood Swings
    Irrational Behavior (even for a 4 year old)
    if she didn't get her way it would be up to a 5 hour out of control screaming fit that nothing would stop. These went away after starting insulin!
    Bedwetting (she never wet the bed)
    Extreme Hunger (she ate more than I did)
    Weight Loss (she lost over 5 pounds in 3 months and she only weighed 40 lbs)
    Lethargy/Pale Complexion

    Symptoms may increase over time. I would request a Glucose Tolerance Test at the very least. Follow your instincts, you know your children best and if something doesn't seem right don't ignore it.

    I hope you get some answers. It may or may not be Type 1 but I'm sure you'd rather find out before one of you precious children end up in the hospital with DKA.
     
  15. Ellen

    Ellen Senior Member

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    If your children are exhibiting symptoms of diabetes, the children should be seen ASAP by a pediatric endocrinologist. If they are overtly ill, (labored breathing, excessive thirst and urination, unexplained weight loss, vomiting, lethargy, etc.) you should take them to the ER. It's unacceptable IMHO that no one at that pediatrician's office has returned your calls.

    Based on what I read in the following, I would not hold stock in the results from this device.


    From an article in the January 2007 issue of Diabetes Care on the relative inaccuracy of the A1CNow

    CONCLUSIONS— The A1cNow is
    not as accurate as the DCA2000. A substantial
    proportion of measurements differ
    from a reference value >0.5%,
    whereas only 3% of DCA2000 values differed
    from the reference value >0.5%,
    which is consistent with our previous report
    (6).


    Furthermore, and probably more
    importantly, there were marked differences
    in values when two simultaneous
    measurements were made, either at
    home by the parents or in the clinic setting
    by experienced clinical center staff.
    Thus, variability among simultaneous
    values does not appear to reflect errors
    in performing the tests by untrained
    parents and patients but instead reflects
    problems inherent to the A1cNow, even
    though the kits we used were NGSP certified.
    Our A1cNow results were consistent
    with those published by Kennedy
    and Herman (7). Using data from 6,231
    subjects, they reported that 32% of values differed
    >0.75% from the laboratory reference
    (Bio-Rad Variant ion exchange) and that 20%
    were>1.0% discrepant. At present, the routine
    use of theA1cNowin children with type1
    diabetes cannot be recommended.


    6. ... from
    Pediatr Diabetes 6:13–16, 2005


    7... from
    Diabetes Technol Ther
    7:907–912, 2005

     
  16. Momof4gr8kids

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    The meter type devise my DD's endo uses sounds similar. The normal for it for a normal person would be a 4.5 to a 5.5. A 7 would equal a average of 140 b/g which I don't think a lot of docs would take siriously if they don't know to much about diabetes, and how slowly it can develope.

    I am a bit suprised at how high the A1c's have been for so many of your children. Do you suspect type 1 or type 2? Also I was wondering if you are concerned about some type of enviromental issue since you've got such a trend there.

    Like the other stated, if you can seek another doc, preferabley a pedi endo. I'd definately ask for a glucose tolerance test, and maybe even a c peptide as well.
    While an A1c can be a great tool to see the bigger picture it is by no means a tool for diagnosis. If your kids are in the begining stages of developing diabetes a A1C would not reflect that. Most doctors wont diagnose diabetes without a fasting of over 129 at the lab, or 200 at the lab post meal, but some endo's still live by the over 300 post meal rule.

    Good luck. I hope you can find out what is going on. Jamie
     
  17. mom2seven

    mom2seven Approved members

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    My 5 (just truned 5) year old weighs only 33lb, eats all the time, always tristy, has awful mody swings and has had a glucose over 200 (on 2 diffrent meters of mine at 2 diffrent times). I have symptoms with all the kids, just the 5 year stands out the most in my eyes without looking at glucose numbers.
     
  18. sheila

    sheila Approved members

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    Have you done a fasting glucose check on the 5 year old? Check in the morning. Also 2 hours after a meal is a good indicator as well.

    Good look and please seek a second opinion.
     
  19. mom2seven

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    sheila,
    No I haven't taking the 5 year old in to the Dr yet. My 3 1/2 year old had the highest A1c so he is going in 1st (Friday at 8:45) but the Dr is ONLY doing a new A1c. I asked DH to ask for a GT & fasting but THEY decided it wasn't needed. I have done a fasting on him myself and it was 138, I can't find my notes on post meals but I'm sure I have seen him over 200.

    I don't understand why my DH and the Dr aren't worried about this!

    I just did Brian's (the 2 year olds) fasting, 126.
     
    Last edited: Jan 11, 2007
  20. sheila

    sheila Approved members

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    Look = luck.

    This is from the Joslin website:
    Normal fasting plasma blood glucose for a person without diabetes is under 126 mg/dl. (just an FYI)
     

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