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Young children's A1c range

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

  1. cdninct

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    In our case, it's that K is five years old and, with the exception of a few hours each morning at school at a time of day when we know he will be at his highest anyway, he is under my complete control, food-wise and in terms of checking and dosing (and prebolusing). I get to flirt with lows as much as I want, knowing that I will be around to catch numbers before they get too low. I am under no illusions that we will be able to keep this up when he starts full-day school and takes more responsibility for himself, but I am certainly enjoying this time while I can get it!
     
  2. Beach bum

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    We had this situation a few months ago. My first response to the nurse was "are you sure you have the right kid?" She said no, what's your secret? Me: "I have no idea how the hell that happened!"

    We did nothing really different, strange. But, we haven't seen that number since. We've seen very respectable numbers, but never a 6.3 again. Of course, we are dancing with puberty right now.
     
  3. Sarah Maddie's Mom

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    I probably should have said an A1c <6.

    My comment was mostly tongue in cheek meant to encourage a poster who seemed defeated.

    Yet, unless your kid is honeymooning you don't get a very low A1c without making choices. "Hard work" isn't enough, at some point that "just work hard enough" has to get unpacked and within there, there are choices that not everyone is willing or even able to make.

    I see it in my own kid - to keep her just at or under 7 we do certain things that work for us, but might not work for another family. We pump and cgm, we never eat fast food, I only bake at the holidays, many dinners are a protein and 2 veggies, she takes packed lunch to school about half the time and so on and so on. These choices are the price we pay for better control. If I were willing to weigh all her food her A1c would be lower still but that is not a price I'm willing to pay. If I were willing to prebolus more and make her wait to eat, lower still, but we suck at that. But I'm sure we do other things that I'm not even conscious of that others would consider restrictive and even obnoxious.

    I'll add that I think comparing A1cs is a terrible idea. There are no "apples to apples" in kids with Type 1 - you've got kids who are perfectionists, kids who are still making some natural insulin, kids who are not in the throws of puberty, kids who are unusually complaint, and then you've got that "phase of the moon" thing when your meter average says 7.9 and the A1c comes back 7.2 :rolleyes:
     
  4. nanhsot

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    This doesn't so much apply to the original post, but this thread keeps me thinking of what many of us are facing the reality of: at some point you have to trust your child to manage this when you are not around to weigh and wake up and remind. My approach has been different than many of yours because my son was diagnosed as a teen, so I never really got to micromanage him. We night tested when necessary but not every night. We weighed food when things were new and we were trying to get a handle/feel for how to carb count. I fully acknowledge I don't have experience with young kids and things are very different for me.

    But at some point you have to let them go to live with this disease. So I guess I'd caution all to not micromanage to the point that I hear some of you doing. At some point you have to trust them to make these decisions, I guess I'd rather work on educating rather than controlling.

    Tight control is very important, no one will argue that. But so is living life.

    My son eyeballs his foods, eats candy and cookies and occasionally pizza, but most of the time he eats very healthily by his own choice. He certainly never weighs his food and I'd be surprised if he even reads labels. He works hard at it, but not in the way I bet most of you would consider good management by your definition. He dislikes being high, never misses a bolus, and corrects aggressively. Looking at his most recent Dex download I will be very surprised if he's over 7 this next follow up. This is without me around, and without any real support.

    Mostly I think he's lucky. I think you can work very hard and get wonky results. You can be lazy and do a reasonable job. You can never ignore it but you can be somewhat casual and still do OK.

    No real point to this but to say that it seems there is a comparison going on here that there is a "right" and a "wrong" way to do it. That's laughable to me. Biggest job I feel I have had in this is to prepare my kid to leave my home, both in dealing with diabetes and relationship and education and character. My job is to release into the world an adult who is functioning, thinking, healthy in character and body. He happens to have diabetes so some of that task was harder than most.

    I'm not personally liking the competition like posting going on here. IMO a certain A1C is not a goal, a range is good but reality is that the goal should be a healthy kid who is not bogged down by this disease, who is able to live life with friends and food and activity, getting plenty of sleep and eating what pleases them.

    As many have said, this is a marathon, not a sprint. It's also a life, so live it.
     
    Last edited: Sep 25, 2013
  5. Sarah Maddie's Mom

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    Nancy, I don't know how you can quote my post and then talk about how much "comparison" and arguing the "right" and "wrong" of managing Type 1 is being thrown about. That's pretty much the opposite of my post.

    And too, having never had a young kid with Type 1 how is it that you can judge those who "micromanage" their little ones? I "micromanaged" my 4 year old because that's what parents of 4 year olds do, with or without type 1. Obviously what I did when she was in preschool isn't the same as what I (or any other parent of a teen) does when they are in High School. :rolleyes:
     
  6. nanhsot

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    I know, I'm sorry, after I hit post I scolded myself for attaching it to your post. That was laziness on my part, not intentional. I was actually supporting/agreeing with you. Sorry. I'll go edit if I can. I DO see lots of "but I..." and "you should..." going on, but not from you. I do acknowledge that those with younger kids MUST micromanage and I have no experience with that.
     
  7. Sarah Maddie's Mom

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    Maybe it's just one of those mornings ;) Sorry I was cranky.:eek:
     
  8. swellman

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    Then I would have to agree that, in our case, going from mid-6's to under 6 would probably require quite a different lifestyle.

    I would also like to make clear that I am not comparing A1cs nor suggesting to anyone how to manage their diabetes. My post was intended to show that we didn't have to go to extremes (by our definition) to get under 7. However, I guess "extreme" is in the eye of the beholder. We have friends that think I'm crazy for making dinner from scratch almost every day with the exception of the occasional chinese delivery. I don't consider this a "price" as I enjoy cooking even making our pizza from fresh dough bought at the grocery store.

    I forgot to mention that we pack all school lunches so that should have been mentioned as a "price". Although, while being an easy way to carefully count carbs I would still do it because the school lunches are gross IMO.

    I will say that our biggest change to get <7 was to change from the PDM Freestyle meter to the Verio IQ. Since then my predictions have been within +/- 0.2%
     
  9. tammy82

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    Ours likes the 7 range and is happy with that. Occasionally it will go into the 8's and that is usually during certain times of the year
     
  10. Dave

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    The D is hard to manage whether your A1C is 7 , 8 or 6...or less than 6. Even if your A1C is 8 its not like your out at the club while your kid is eating whatever they want. You STILL have to work at it.

    Since you have to do so much work anyway, might as well go for the 6: go low carb, go unprocessed food for the most part, learn some cool recipes, spread meals out, pre-bolus, eat an early dinner and get that night blood sugar in a very good range....test test test. Its not that much work, just a little more, and obviously has huge implications.

    Have to keep the kids healthy for the next ten years because dramatic changes in management and possible cure are really coming.
     
  11. Sarah Maddie's Mom

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    My comments in purple above

    As to the 'you're already working hard' ... well, how "hard" a parent wants to work is one thing - how much you want your kid to see you laboring is another. They know everything. The see everything. They internalize everything. How much stress a person wants to take on in D management is never, ever just about the caregiver.
     
    Last edited: Sep 26, 2013
  12. Christopher

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    Originally Posted by Dave

    Since you have to do so much work anyway, might as well go for the 6: go low carb, go unprocessed food for the most part, learn some cool recipes, spread meals out, pre-bolus, eat an early dinner and get that night blood sugar in a very good range....test test test. Its not that much work, just a little more, and obviously has huge implications. From that you can expect perhaps a 7.5 (assuming one is managing a non-honeymooning kid) To achieve a 6 you will need; a cgm, a cooperative child and willingness to set your high thresholds very low, i.e., 120 and to correct at that level. For younger kids you'll have to be on top of every singe party, holiday, vacation and likely say "no" to a great many foods. For an older child you'll need strict attention to parties, sleepovers, hormone cycles, sports, eating out with friends and more Have to keep the kids healthy for the next ten years because dramatic changes in management and possible cure are really coming.




    I know you are new to all this and if you want to manage your child's diabetes in this way that is your choice. I personally think going low carb is not a good choice for a child who is growing and developing. I also don't think your "recipe" for an A1c under 6 is accurate or realistic. Saying no to a "great many" foods and micromanaging their daily activities may get you an A1c under 6, but the damage it may do to them emotionally/socially is not worth it, in my opinion.

    In the beginning, some people do focus specifically on the A1c and use it as a goal. However, as time goes by, many of us tend to look at things more holistically, taking into account the emotional, social, and mental well-being of the child, in addition to the A1c, blood glucose numbers, etc... It really is a balancing act and it is not an easy one.


    I would also be interested to hear about this possible cure that is coming in the next 10 years.
     
    Last edited: Sep 26, 2013
  13. Dave

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    The low A1C is tantamount. Studies prove without a doubt that it is the key to limiting complications - for example there is a recent post here talking about a longitudinal study of folks with low and high A1C.

    Since diabetes is a disease of carbohydrate intolerance, it only makes sense to limit carbohydrates as best you can as a first goal to improve A1C.

    However, you have to be careful with low carbohydrates and growth - no doubt. Insulin is the key to growth. If you cut carbohydrates, it is very important to make sure that your child remains on the same growth curve that they were pre-diagnosis. They still need insulin.

    And there is a way for a child to get more insulin to grow without eating spikey meals that raise them above 160 - protein. Protein turns into glucose very slowly. A high protein diet allows one to remain on his growth curve, get enough insulin for growth and avoid spikes as much as possible.

    The cure - well you should be very confident. We are living in the decade before biomedical revolutions, the 2020's. Just as the 80's were to computers, so it is now with biotech. Diabetes is going to be one of the first dominoes to fall - its a much simpler disease than say cancer. There are so many avenues currently being explored - so much that is now understood than even 2 or 3 years ago.

    Sans a cure, it is easy to extrapolate the current technology - just talk to an older type 1 who has a dexcom about what life was like in the 90's compared to today. Just investigate some of the human artificial pancreas trials...I'm quite confident...you too should feel hopeful. :cool:
     
  14. caspi

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    I couldn't agree more. My son is almost 15. In a perfect world he would eat "all things healthy" all the time. But that's not realistic for us. He also plays sports. His A1C is in range but striving for something under 6 ? It's just-not-gonna-happen. Not now at least. ;) Does that make me a lazy parent? Absolutely not. It makes me a realistic one. He's going to eat pizza, he's going to eat late some nights, heck - he's a teenager - he's going to EAT. ;)

    And as far as that cure..... While not totally giving up on it happening, I'll believe it when I see it. :cwds:
     
    Last edited: Sep 26, 2013
  15. danismom79

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    I'm glad you've got this all figured out after 6 months. I'd be interested to hear how you make out over the next 5 years or so.
     
  16. MamaC

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    I remember the 6.1 three months after diagnosis. Yup, I do. That was a singular highlight.

    I remember the "five to ten years" advice. That was a fail.

    After 7.5 years I remember a lot. I hope that everyone has more success with hard work and diligence that I've had.

    I didn't know anything substantive about T1D on May 2, 2006. I knew a LOT more on May 3, 2006 after an overnight session on the internet. I learned more during a three-year honeymoon. Then teen hormones and sports and a growing boy's appetite slapped me down, but good.

    Get a handle on it, but realize your grip will almost certainly change as the CWD grows.
     
  17. Mish

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    Sometimes, I think at 8 years in, I know less than I knew early on. ha!

    I said it earlier, up thread. If trying hard, and doing everything you were supposed to do gave us all the same results we wouldn't be having this conversation. I cook just about everything from scratch. I feel my kid fruits and veggies. We eat a pretty varied diet of good foods and (homemade) bad foods , but the bad are always in moderation. My son isn't a junk food eater, or a candy eater, or a soda drinker. We eat some 'whites" and some "wheats" . I make sure he gets a good night sleep and a modicum of exercise . We see the dentist regularly, lather rinse and repeat, look both ways before crossing, and always make sure our underwear doesn't have holes. And yet, there are times, most of the time for lots of us, when none of that matters.

    Seriously, it's incredibly insulting for people to sit and think they have it all figured out, cluck their tongues and think that the rest of us must be doing something wrong. If diabetes were a paint by number project, I'd be always in the lines, and I'd have a mona lisa and we'd all have the same mona lisa at the end of the day. I have something that resembles art done by a drunk monkey.
     
  18. Mish

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    oh I just saw this. I'm laughing. :D It's so true.
     
  19. caspi

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    Agreed. But I'm willing to give the poster a free pass as we all know that in time his views will change. It's almost like a new mother - they think they have it all figured out until reality slaps them in the face. ;)
     
  20. 3kidlets

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    For one year, Hana's A1cs rode in the very low 6s. I was convinced we had this. No biggie. Then one day her pancreas just completely shut off for good. Not to long after that, puberty hit....and yeah

    As far as a cure, my father in law was dx about 35 years ago. He was told a cure was a few years away.
     

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