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Young children's A1c range

Discussion in 'Parents of Children with Type 1' started by missmakaliasmomma, Sep 22, 2013.

  1. wilf

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    Testing 5 times a night is just too much - it is not sustainable. D management is a marathon, not a sprint. You don't want to burn yourself or your daughter out.

    Ease up just a little - you'll be glad you did in the long run, and it won't hurt your daughter. :cwds:
     
  2. kiwikid

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    Yes I fell in love and my kid won't use it... at 12 shes rebelling about everything. As a little kid I could have talked or bribed her into anything. I am also cringing at numbers that will correlate to a 9 or 10 HbA1c... If you have the technology and you can get your child to use it I would go for it - don't hesitate. Our HbA1c's when she was aged 3-10 were always low 7's.... I wish wish wish for those again..
     
  3. swellman

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    I'm not sure if by your quote we are in agreement or disagreement.

    The goal, in my opinion, is to safely obtain the lowest A1c in order to minimize long term complications. To make peace with the disease is, to be frank, not one of my goals. I have no problem with my child struggling with the fact he has an incurable disease as long as he knows that he is doing the best he can to minimize long term complications. Unfortunately, this is his albatross and I can't imagine myself telling him it's OK to "be at peace" with diabetes when the results are fairly certain.

    Eff making peace with diabetes.
     
  4. wilf

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    Time to think about this a bit more, my friend.

    The results are not at all certain. And Type 1 D is a condition our children will have to live with for the foreseeable future, if not the rest of their lives. Best they accept this part of their genetic heritage (together with the intelligence and great looks and whatever else they also got as part of the package), and get on with living a full and happy life.

    There's more to their lives than getting best A1C..
     
  5. missmakaliasmomma

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    I agree, it is too much however, my body has gotten so used to it, it's weird. I will wake up when I usually test her anyway, even without an alarm. So because I get up, Im like why not test her to make sure she's ok? I'm one of those paranoid mothers lol. I'm not a good sleeper anyway. I'm really glad she's a heavy sleeper and doesn't wake up easily at all, so one of us is getting sleep lol. Since having my son in july, I actually have eased up a bit (believe it or not). Going back to mdi has helped me ease up as well.
     
  6. Beach bum

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    And part of the goal should also be to have parents who, while devoted to the care of their child, do not become slaves to the disease. Testing 5 times a not is not unusual in certain situations while not on a CGM (illness, stubborn high, stubborn low and the odd bad set), but it shouldn't be the norm. Yes, you may think your child may sleep through the tests, but most times they are aware that you are in the room. My daughter mentioned this one time in the docs office. They asked what annoyed her about diabetes and her response "my mom coming in and testing me all the time at night, she doesn't think I wake up, but I do." This was after a change in insulin regimen, but before the CGM, so I was testing 3 times a night.

    I would be concerned with burnout. For both your child and you. I'd ask myself "am I checking her frequently to make sure she is OK, or am I checking her so that I'm OK?"
     
  7. StacyMM

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    We're seven years in and I'm thrilled anytime we are in the 7s. At that age, DD was usually in the 8-8.5 range. She's in the high 7s usually, now. We did go to a little over 8 after switching to OmniPod and adding the Dex - but those changes coincided with growth changes and early puberty swings in basals so I'm still perfectly happy with that number. DS has only had his a1c checked twice since diagnosis and it's been 7.1 both times, I think. That's the magic of the honeymoon because we seem to spend 10 times more energy getting DD into the 7s at all than we do at managing him to a 7.1. We're heading into puberty with both so I have no goal at this time. We just do the best we can every day and what will be, will be. I'm all about dealing with each day and not focusing on a number we see every 3 months. If I was focused on a 7, I could run them low on a regular basis and change their target to 80 and schedule their diet in a restricted way. That's miserable for them, though, so I'd rather manage to 100, let them eat when they are hungry and try to maintain as consistent a number as possible.
     
  8. Melissata

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    Testing her 5 times a night is WAY too much, even if she doesn't wake up. I'm going to just say what everyone else is thinking, and that this is way more about you than about her. I do understand the not wanting to see something attached to your child, but you need to do it for her sake. If you feel like MDI is better for her for now, then fine. But testing her that often and having so many lows when she is so young and hypo unaware just doesn't make sense to me when you could put her on a Dex. It is not that big at all, and certainly would fit under her clothing.

    And she is only 4, you can sell her on a CGM easily if you have the right mindset.
     
  9. Beach bum

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    It really wouldn't hurt to try. But, you know what's best for your child. But here goes with my 2 cents.

    First, my daughter started pumping at 4. We used her butt exclusively back then. She danced, skied, gymnastics. Sliding down the slide. Swimming in the Atlantic Ocean and being tossed around like a rag doll. Never a kinked cannula from those activities. The only times it did kink was due to my error putting the set in.

    While the Dex has a bit larger footprint than a set and it is a bit higher, there are rarely times when it interferes with my daughters day to day life. She wears it almost exclusively on her arms, but if her skin gets a bit irritated we switch to her hip and for a bribe, her stomach. The Dex insertion does not lead to scar tissue like the infusion sets do, so you can use areas over and over easily. We tend to go arm, hip, arm, hip.

    If you can swing it, I'd say try for the Dex. She may put up a stink, but remember, she is a child and you are the ones who decide about her medical care. It would make your life a bit easier, you can still get up to check, but instead, you can check the CGM and not the child. That's one thing I love. I still will set the alarm but I can make a determination of dosing based on where the CGM says she is.
     
  10. missmakaliasmomma

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    Thanks everyone, I appreciate the positive responses. I looked up a picture of dex on kids and it doesn't seem too too bad. I do hope one day she will be ok with using her stomach (when she gets more fat of course, right now it's like rock solid lol)

    On our next dr's appt I will ask the dr more about it. I know she will need to write a letter of medical necessity because I was told before that my insurance doesn't cover it.

    Is this something dr's will only put pumping kids on? Or do they seem to be ok with doing it for mdi kids too? It just seems to me like there's more kids with a pump and dex as opposed to mdi and dex...
     
  11. cdninct

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    While it makes no sense that endos would be more likely to approve CGMs for kids that are pumping, some clinics are just plain dumb about stuff like that. Ask, and see what they say, but know that there is no reason why CGMing has to be done in tandem with pumping--and fight, if that is the way you want to go.
     
  12. Beach bum

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    I'd call and speak to Dex about it, the equipment provider can usually work with insurance (along with supporting docs) to get things covered. They know how to phrase the questions in just the right way.

    No, anyone can use the CGM. We have a friend (40+ years T1d) who is can only take Humalin and Humalog (long story) and is today sitting in CGM training as we speak. I think you see more kids on pump/CGM because of the fact that most of us have been doing it a while and so step 1 for us was to get a pump, then the next big thing to roll out was the CGM, so most of us wanted to get that next. I think the CGM will be a valuable too, especially if you choose to stay on MDI, I think it will really help you keep track of what her body is doing.
     
  13. Shopgirl2091

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    We were on the Dex a month before we started pumping, and I would keep the Dex weather we were still pumping or not. There should be no issue with having a pump or not having a pump, it is a completely separate device.

    I would say if you are interested, and want to push for it too - your doctor should be able to write a letter of medical necessity that should override the insurance's denial.

    In our case my son had multiple documented hypos, and that along with the doctors letter was all that was necessary to get the insurance approval.

    I'm not a big fan of having all this equipment attached to my kid either - I don't think anyone is - but the difference of being able to see what the diabetes is doing all the time - not feeling blind anymore, feeling like I have to test test test, because he's probably fine, but what if he's not and I didn't catch it. With the Dex I don't have to worry about that. I still worry about him going low, but I know it is going to tell me long before he is having a problem that I need to be aware there is an issue.

    The only downside for me is the two hour start up period where I am blind again. I would try arms if I were you - my son is four too and it fits perfectly, he doesn't bump it or even hardly notice it is there. Just my two cents :)
     
  14. Lisa - Aidan's mom

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    My DS is MDI and Dex.
    Good luck with your decision.
     
  15. mom24grlz

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    I'm going to agree with this statement. I do not have a young child with diabetes. Ashleigh was dx at 11. My nephew is 7 and i think his endo wants his A1C between 7-8%. That being said Ashleigh has always had an a1c in the 5-6% range (not counting her initial 15.2% at dx). Her current A1C, taken this month was 5.9%. She did mdi for 8 months and is now pumping. She does not use a cgm. She does test herself 10 or more times a day. She counts carbs and does not do any SWAGing, unless absolutely necessary. Corrects at bs above 125 during the day, and 140 at night. We do have occasionalhighs and lows (i'd like to meet a diabetic who doesn't). But i firmly believe her A1C are do to her tight control and how we (she and I) manage it.
     
  16. hawkeyegirl

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    Well, of course it's possible to get an A1C in the lower 6s. No one said it wasn't. However, it's not possible for some of the people all of the time, and it's not possible for most people at least some of the time. And it's possible to have a "good" A1C with pretty poor control. That, and the wide variability of actual average BGs in T1s with the same A1C makes it a fairly faulty indicator of success, in my opinion. (And we have good A1Cs, so I'm not just being a Bitter Betty here. ;))

    Listen, everyone is dealing with their own circumstances, each of which makes it easier or harder to get a "good" A1C. Age of the child, school situation, child's willingness to put up with a lot of BS, child's food preferences, familial support, money, honeymoon status, pump/MDI, CGM, puberty, parent's ability, child's ability, child's biochemistry, luck, and the phase of the moon, just to name a few.

    Anyone who thinks that all it takes is hard work and know-how is going to get a rude awakening at some point.
     
  17. MamaC

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    CGM (G4) here, no pump. No issue with that from the endo.

    If I had to choose one device over the other, I'd choose the CGM. And essentially, that's the choice my 20 year old son made.

    Is it magic? No.

    Does he love it? No. He tolerates it and recognizes its value.

    Do I love it? Yes. A lot.

    And those lower 6 A1Cs? Haven't seen one since 3 months post dx. Not for lack of trying, or crying.
     
  18. Nancy in VA

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    I want to echo hawkeyegirl. In reading here for 6 years, I've come to the conclusion that some people have an easier time managing their diabetes. I see those that talk about little to no spike, carb factors that are on the nose, etc. I am convinced Emma is not one of those people. Even starting at 70, a low carb breakfast is going to take her into the mid-to-upper 200s. It just is. She goes through growth spurts and I can't keep her out of the 200s. I'm just convinced that while others may be able to achieve a low to mid 6 A1C, its not in the cards for us. I will try to keep her as close to 7 as possible, and as is healthy. She had 2 seizures a year ago from lows, and trust me, I'd rather run her in the upper 180s and have an A1C of 7.5+ before I subject her to that again. You don't need an A1C of 6 to reduce future complications. Every tenth of a point that you can reduce your A1C will help reduce future complications - so once you get to a point that you believe is what YOU can manage for YOUR situation, that's what you work towards. I couldn't keep Emma under 150 all day if I monitored every minute of the day - its just not going to happen.

    And as someone said higher up, managing diabetes is NOT a sprint, its a MARATHON. You can't continue to "check, check, check" just because you have to know. Unless you suspect she'll be low / high, due to trends you've seen overnight, you don't have to check every 90 minutes, which is what 5 checks a night basically is. We don't even check that often during the day, and she is awake and eating!!

    Relax and know that as long as you stay on top of managing her diabetes, it IS in control - your control, regardless of what that A1C says!
     
  19. Mish

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    I think this is SO important. If A1c was a reflection of nothing but how much work you put into diabetes management then most of us would be rocking mid 5, near normal a1c's. Instead, it's a reflection of BGs. Nothing more. Nothing less.

    Anyone who has a child in puberty will tell you that it's not that easy. We do everything the way it's supposed to be done; we log bg's we download meters and CGMs , we accurately weigh food and count carbs, we change ratios and basals as soon as we see trouble. And I have a very, VERY, easy going 13 year old who is perfectly happy to check bg's and bolus appropriately at school, and is equally as happy to let me do it at home. In short, we're still in the "good" teenage years, and yet BGs suck and a1c reflects that. And that's coming from having fairly good a1cs in the high 6s and low 7s the first 5 or 6 years after dx. So we do know what we're supposed to do.


    So it's some what insulting for another parent to even remotely suggest that good a1c is a reflection of "how we (she and I) manage it." It simply isn't.
     
  20. Beach bum

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    LOL, the last one we saw was actually just a few months ago, post CGM start. Other than setting the 90 as our low and doing some temp basal increases based on trending arrows, we didn't do anything our of our normal routine.

    So, basically I'm saying that we really didn't anything different. I'm still trying to figure out how the hell we got a 6.3 A1c. I actually said to the nurse "are you sure we are talking about my kid?"

    We work hard at managing diabetes, but she's a kid who's entering puberty, she manages her diabetes on her own 75% of the time. And I have to say she does a pretty darn good job at it! I'm happy when we see a 7. Do I know it can be better? Yes, do I loose sleep over it at night? No. My daughter is happy and healthy, that's all that matters.
     

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