September 29, 2009
A1c (Glycohemoglobin, HgbA1c)
Question from Cocoa, Florida, USA:
My 16-year-old son’s numbers seem to run high and the endocrinology team, sadly, doesn’t always seem to get it. He just had blood work almost three months ago and his A1c had gone up to 9 from a previous 8. We go back the end of October and I’m worried he may have gone higher. The endocrinologist was hoping my son would take charge of his diabetes by then.
I know my son takes 42 units of Lantus a night and between nine and 12 units of Humalog a day. He administers his own insulin. At school, he goes to the nurse’s office, but the nurse does not always observe him checking his blood sugar and taking his insulin. I do sometimes watch him check and take his insulin. He has always done his own care since his diagnosis about 14 months ago. I check his meter also and his blood sugars are sort of high. Is there something I am missing? The endocrinologist checked his kidneys and checked for celiac. There were no problems with either.
Answer:
If his A1c is 9, your son clearly is not getting enough insulin on a daily basis. The first step is to ensure insulin delivery by observing insulin dosing at school and at home. Once you have a better idea of the amount of insulin he is taking, you can make adjustments to dosing to achieve the A1c for which your son is aiming. He has to be a willing participant on the team. Bad attitudes will result in poor diabetes control. Do all you can to positively reinforce his great care of his diabetes.
MSB
[Editor’s comment: See also some of our previous questions on A1c, glycohemoglobin, HgbA1c and Behavior.
BH]
