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July 18, 2005

A1c (Glycohemoglobin, HgbA1c)

Question from Covington, Louisiana, USA:

My 14 year old daughter has had type 1 diabetes since the age of four. Her A1c has been consistently below 7.0, 6.4 to 6.7 on average. The last two have crept up to 7.1 and 7.2. I realize that the ADA recommends below 6.5, but with the stresses of puberty and being a teenager, is this common? Her father (we are divorced) is convinced that she is overeating and "cheating," but, if anything we have modified her diet and exercise program to make it more healthy. For her peace of mind, what is the average A1c of a type 1 diabetic teenager? Of course, we have talked to her practitioner and he has made some suggestions, but I would like to know if this is abnormally high, or if her father is overreacting. I think her stress level would come down if she knew this.

Answer:

The A1c levels you report are excellent for anyone with diabetes and especially for a teenager. You are correct that the teenage years are more difficult to manage because of somewhat unpredictable hormone fluxes, growth, etc. If you can keep the A1c level below 7%, the vast majority of the time, despite some occasional blips in the low 7 range without severe episodes of hypoglycemia, then you are all doing well. The question of overeating must also be placed into context with her weight; if she is overweight, then likely she is overeating or underactive or some combination, with or without diabetes. So, I would go back and discuss this with your diabetes team.

SB