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September 27, 2010

A1c (Glycohemoglobin, HgbA1c), Hyperglycemia and DKA

Question from Spokane, Washington:

My 13-year-old son has had diabetes for 11 years. As he heads into puberty, we are struggling with high glucose readings and high A1c numbers. Currently, his A1c is 11 and the doctor is working with us to help him through this troubled times. However, the diabetes educator told me today that the results of not getting his numbers down consistently to under 300 mg/dl [16.7 mmol/L] (he has been over 400 mg/dl [22.2 mmol/L] at least once a day) is "borderline neglect." I interpreted this as a medical professional telling me I am an unfit mother. I am very upset by the comments as I struggle every day to have my son test and give insulin. What can I do more of to help get his numbers where they need to be? I am very frustrated by his glucose readings and by the medical professional's comments. My husband and I are often reminding our son to check and give insulin. Can you help me understand why I should do all my son's his testing and insulin (as I was advised)? Are there studies that show this? The reason I ask is because he wants to do it but he doesn't. He's a teenager. I don't understand what he wants to do but he doesn't follow through. He feels like I am embarrassing him if I take charge and, yet, he wants to be independent, but he's not. Do you have any suggestions?


Research by Barbara Anderson, Timothy Wysocki, Lori Laffel, and Donna Follansbee have each independently determined that teens who are expected to be independent in their own diabetes care (meaning little adult supervision or support) not only show worse adherence to their diabetes regimen, but they also show worse blood sugar control, worse A1c�s AND they are less likely to adhere to their regimen when they go off to their first apartment or go off to the dorms at college. The data suggests that parents need to do more than merely remind their adolescents to complete their diabetes tasks, but that they must still be responsible for at least some aspects of the daily regimen, which may mean doing tasks during the time of day when the teen is most likely to forget. This evidence is consistent with the adolescent development literature, specifically the literature on brain development, which shows that the parts of the brain that manage our sense of risk, our impulse control, our ability to plan and organize, and our ability to think about the future are the very last parts of our brain to finish developing. In fact, our frontal lobes (the part of the brain responsible for all of these things) are not finished developing until our mid-20s.