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August 16, 2008

A1c (Glycohemoglobin, HgbA1c), Complications

Question from North Carolina, USA:

My 13-year-old daughter was diagnosed with type 1 diabetes at the age of two. About two years ago, she stopped caring about taking care of her diabetes and her A1c has been increasing. Her last two A1cs where both 13.1. Her doctor called me this morning to tell me they want to re-run the test because her levels where elevated. They told me to take her in the morning because that would give them a more accurate test. I know she has had diabetes for 11 years and her A1c is not good, but isn't she too young to start having complications or is this not surprising given the A1c? And, what is an elevated protein level?

Answer:

Unfortunately, your daughter is NOT too young to develop complications from her diabetes mellitus. I tell my patients that, in general, five years of inadequate control leads to higher risks of diabetes-related kidney disease, eye disease, circulatory problems, nerve damage and others. And, unfortunately, it is not necessarily five years “in-a-row” of sub-optimal control but rather five years cumulative!

But, I have had patients in really good control still develop kidney related problems and I have had patients in pretty stinky glucose control who have no problems (now).

I suggest that since you recognize that your daughter’s motivation to stay in good control has faltered, YOU take complete charge of her diabetes for the time being: you check her glucose, you check carbohydrates, you give insulin accordingly, you check her for ketones, etc.

As for the “elevated protein level,” I presume this was in the urine and this is the test for which a morning value could be more accurate. The presence of extra protein in the urine of someone with diabetes mellitus is typically the first clinical clue as to the development of diabetes-related kidney disease. Don’t ignore this.

DS