April 28, 2005
A1c (Glycohemoglobin, HgbA1c), Insulin
Question from Brisbane, Queensland, Australia:
When I was 13, my blood sugar levels were all over the place and I suffered three seizures due to low blood sugars. My specialist corrected this by changing me to Humulin N and Humalog. Since then, I’ve had an A1c of around 7.4 and hardly any trouble with my sugar levels.
I am now a healthy 17 year old and my new specialist wants me on four injections a day. According to him, my A1c was 8.4. Three weeks before this, my A1c was 7.5. When I questioned this, he then told me that the readings can vary dramatically from machine to machine! My mum also has diabetes and they did the same to her 10 years ago. Since then, she has had problems constantly including temporary blindness and the need for a kidney transplant. How accurate is the A1c and does it sound like I need to change my insulin based on this?
Answer:
The A1c is a very accurate tool to estimate the average metabolic control over the last two months prior to its determination. I fully agree with the new specialist you saw as the intensified insulin regimen based on glargine (Lantus) basal insulin plus lispro or aspart before each meals is actually the best regimen a young patient can be given. Try it and I’m sure you’ll shortly see its real advantages in terms of metabolic control as well as in quality of life.
MS
