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June 11, 2002

Complications

Question from Coutenay, British Columbia, Canada:

My 15 year old son has had type 1 diabetes for 11 months. He is growing, his eating habits are changing, and I know what he must do, but I need to inform him of what damage a high A1c (10-14%) is doing to his body. He does not fully appreciate the danger. How much damage does a year-long high A1c do to a body? I am well aware of amputations and blindness, and I want to inform my son. Where can I get blunt information about the dangers of death if not controlled?

Answer:

Any diabetes teaching manual will provide such information. The higher the sugars, the worse the control, the higher the hemoglobin A1c, the worse the long term prognosis: eyes, kidneys, nervous system, penis, circulation, heart, brain, etc. These are problems that occur over many years.

The short-term problems reflect the dangers of DKA [diabetic ketoacidosis], dehydration and coma/death. These are all increased in kids, teens and adults whose sugars stay high.

You may want to have your son’s diabetes team discuss this very directly with him. If he has some resistance to taking better care of himself, he may need some additional evaluation by a psychologist, psychiatrist or social worker as well as the other diabetes team members to see where the barriers are. Sometimes teens do significantly better when parents resume direct control over testing, eating/meal planning and insulin administration. The web sites of the American Diabetes Association, British Diabetes Association, Canadian Diabetes Association , Juvenile Diabetes Research Foundation, and Children with Diabetes can also provide such information.

SB