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Tight Control

I am baffled by the ADA recommendation, one that is oft cited by the Ask the Diabetes Team members, that an A1c (or glycosylated hemoglobin) should be less than 1% above the upper limit of normal for the lab performing the test.

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My 10-year-old son was diagnosed 5 months ago. When we went to see his endocrinologist last month, his A1c was 5.5. I thought that was great news. However, the doctor didn’t share my joy and said he wanted to decrease his nighttime Lantus because a normal A1c level at this stage makes him a good candidate for hypoglycemic episodes that may happen without warning.

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I am a 16 year old female and I have been living with diabetes for eight years. When I turned 12, my blood sugars would stay up no matter what I did. I am doing the best that I can for a 16 year old. When I am under stress, my blood sugar goes up and my doctors yell at me. What can I do to be in more control of my diabetes?

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I’m not sure my A1c of 5-6% is good enough. The way I see it, patient A’s glucose may only vary only a few points throughout the day, and patient B’s glucose may vary very widely. Although both would have a mean reading that’s similar, wouldn’t more damage be done because of the greater fluctuations?

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I had my diabetes under good control until my doctor increased my dosage of Synthroid. Does the Synthroid affect the blood sugars? Wouldn’t I be better to have my thyroid on the “low side of normal” with lower blood sugars?

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My daughter, age 12, was diagnosed two months ago. She is currently taking NPH and Humalog twice daily. We seem to have problems keeping her within range. Would a regimen of other types of insulin with more frequent injections allow us to keep tighter control?

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We are planning to ask my daughter’s endocrinologist to switch her from Humalog with NPH to Lantus with NovoLog. We are hoping that this new regimen will give us more flexibility and keep her blood glucose levels more even. Do hemoglobin A1cs tend to improve when people switch from NPH to Lantus?

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In poorly controlled diabetes, are growth hormone levels higher? Does tight control mean one may not grow as much?

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I am 40 years old. I am on 15 units of Regular and 15 units of NPH insulin in the morning and 5 units of Regular and 15 units of NPH insulin in the evening. I think that I am eating right, but for whatever reason, my sugar level is high. What can I do to bring it under control?

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I am 35 years old, have type 1 diabetes, I am on a four shot a day program with Lantus and Humalog, and my last A1c was 6.3%. What is the target that is suggested for people with type 1 diabetes in order to maintain good long term health? How will going on the pump help make my control better than it is now?

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