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What is the optimal range for the hemoglobin A1c?

Discussion in 'Parents of Children with Type 1' started by Corinne Masur, Jan 23, 2010.

  1. Corinne Masur

    Corinne Masur Approved members

    Aug 17, 2008
    Help us solve a family argument - what is the optimal range for hemoglobin A1c? What are the arguments against having one that is quite low?
  2. Kalebsmom

    Kalebsmom Approved members

    Aug 29, 2008
    I am pretty sure it depends on the age of the child. Our endo does not want Kaleb's super low because it could mean he is having a lot of lows. His is 6.3 and the endo said she does not want it any lower.
  3. wilf

    wilf Approved members

    Aug 27, 2007
    The optimal range is the lowest you can reasonably achieve without encountering severe lows and without obsessing about the diabetes to the exclusion of the important things in your life.

    The answer is different for every child and every family. Recommended ranges for children your age are around 7% to 8%, but it may become exceedingly hard to achieve such A1Cs as your son goes through puberty.

    Good luck! :cwds:
  4. s0ccerfreak

    s0ccerfreak Approved members

    Mar 17, 2007
    I just wanted to say that is the best response I have ever heard! I'm 19 and my endo is fine with an a1c around 7.
  5. Toni

    Toni Banned

    Sep 14, 2009
    IMO, it would be the lowest you can get it without excessive lows. We have not been able to achieve the high fives since about a year after honeymoon even when using cgms. And usage of cgms did not lower her A1c which usually trends to the low to mid sixes. Endo recently said that A1cs in the low 7s are okay with her as teen and young adults start to self-manage. I would aim for that.
  6. Darryl

    Darryl Approved members

    May 8, 2008
    There are three answers to this question

    (1) The lowest you can achieve without significant hypglycemia.

    (2) What your endo is OK with.

    (3) What the human body is designed to tolerate, and which will likely keep a child safe from complications of D. This is more a matter of science than opinion, and the best data we have is from the DCCT study. The complication risk for retinopathy based on A1C in figure 1 of this article: From this you can see there there is no "right" answer, it's just a matter of how much risk is acceptable.

    Of these,

    (1) is the only realistic answer, but leaves room for improvement by employing the best available methods, attentiveness, and technologies.

    (2) is meaningless in my opnion, unless the Endo recommends (1) and provides the training and support to help you minimize A1C safely. Endo's recommended A1C is particularly meaningless if they copy it out of a book written be any of the renowned diabetes book authors, where A1C's are recommended by age rather than by choice of BG control techniques.

    (3) reflects reality.

    The best answer, however, is that A1C an indirect measurement of BG control, representing a 3-month average. As the study linked above shows, variability is also a key factor. We don't shoot for any A1C, rather, we shoot for keeping BG in the non-D range as much as possible. I believe a better target than A1C would be to keep BG in the 70-140 range as much as possible.
  7. selketine

    selketine Approved members

    Jan 4, 2006
    Yes - I totally agree...your a1c is a snapshot of all your blood sugars averaged together. So highs averaged in with many lows can give you a wonderful a1c but horrible blood sugar management.

    I think if your child is on a cgms then trying to keep the blood sugar in range (hence getting a low a1c) is still not easy but at least lets you know that you are not experiencing a ton of lows just to get that pretty A1c number.
  8. Nancy in VA

    Nancy in VA Approved members

    Jul 16, 2007
    I agree with those above. The A1C is an important measure but its more important to know what type of "Range" that is reflecting. If you achieve a 6.5% but constantly have swings from 50 - 300, that's really not good. If you achieve a 6.5% because you are maintaining a 110 with swings sometimes into the 70s and 150s, that's a good #.

    For us, the lows are problematic because Emma, even after 3 years, shows no outward signs of a low, so we try to run her a little higher to avoid them. The CGMS has helped us run her a little tighter
  9. Beach bum

    Beach bum Approved members

    Nov 17, 2005
    Great answer!
    I too agree that you want to be as low as possible, but not obsess about the number or your child going constantly low.
    This is the written chart our endo has as reference on each of our A1c letters:

    A1c Average glucose Interpretation
    4-6 under 135 Reference range
    6-7 135-170 Goal-excellent
    7-8 170-205 Good control
    8-9 205-240 Fair control
    9+ 240 and above Needs work

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