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January 23, 2002

Daily Care

Question from Columbus, Mississippi, USA:

I am 11 years old, I have the insulin pump, and I recently got my A1c test result back which was 8.3%. I want some help on how to get it down.

Answer:

Here are some tips to reduce your hemoglobin A1c:

Test your blood sugar more frequently and act on the results.
Review carbohydrate counting and calculate your food intake to insulin ratio more carefully.
Don’t forget to bolus.
Your situation might well be clarified by monitoring sugar levels continuously for several days to try to sort out what’s happening in more detail and to fine tune your treatment regimen. See The Continuous Glucose Monitoring System. Ask your diabetes team about this procedure.

HVS

[Editor’s comment: First of all, I’m really proud of you for wanting better control and writing to us! Heather’s ideas are great, but let me add a few more thoughts.

While it could be lower, your A1c isn’t so far off that you can’t keep working at it. At your age, you may be starting to become an adult, and the changes that happen in body at this time, make it really hard to have blood sugars where you want them to be all of the time. The increase in sex hormones also cause blood sugars to be high, and, at the same time, make the insulin you get less effective. So, even though you might be doing everything you were told to do, there are always things you can’t control, and I don’t want you (or anybody else) to be angry with you.

The other thing to remember is that you can’t do this all by yourself. You’ll need lots of help from your parents, your doctor, your nurse, your dietitian, and everyone else on your diabetes team. Don’t be afraid to ask for that help! You might tell your mom and dad that you want to set up a meeting with your diabetes team because you want to lower your A1c and need to work with everyone to develop a plan. If your parents don’t want to, call yourself and have someone there set up an appointment.

There are lots of books that might help, but you’ll need help from your parents to understand them. Ask mom and dad if you can buy one or two to help. Some of are:

Teens Pumping It Up: Insulin Pump Therapy Guide for Adolescents by Elizabeth Boland, MSN, APRN, PNP, CDE
Pumping Insulin: Everything You Need for Success With an Insulin Pump by John Walsh, Ruth Roberts, MA, John T. Walsh PA, CDE, Barb Schreiner (Editor)
Optimal Pumping by Linda “Freddi” Fredrickson, MA, RN, CDE, Richard Rubin, PhD, CDE, and Stefan Rubin
Complete Guide to Carb Counting by Hope S. Warshaw, Karmen Kulkami.

Once again, thanks for writing, and I hope you reach your goal really soon!

SS]