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May 20, 2004

A1c (Glycohemoglobin, HgbA1c), Complications

Question from USA:

My seven year old son was diagnosed with type 1 diabetes five months ago. His A1c was 8.5% at that time. With the beginning of insulin administration, his A1c quickly, over a period of one month, dropped down to 5.8%. Two months ago it was 4.6% and now it is 4.5%. While our doctor considers this to be a perfect improvement, I am somewhat concerned about possible negative effects of such drastic changes in his A1c. I have learned that quick improvements in blood glucose levels can trigger the progression of diabetic retinopathy, as shown on people with a long history of high A1c values. However, I have seen no information on whether this can be dangerous for children with a short diabetes history. Could you please comment on that? Should I in this situation suggest a visit to an ophthalmologist?

Answer:

There is no concern with such nice and rapid improvement shortly after diagnosis and suggests that some of your child’s pancreas is probably working a bit, something called the honeymoon or remission phase. Unfortunately, this does not last a very long time, but it is nice while it does. The better the glucose control, the longer the honeymoon. The younger the child, the shorter the honeymoon until late teen and young adulthood when the honeymoon is often longer.

As far as retinopathy associated with rapid changes in A1c and glucose levels, this is also true but does not apply to early stages of diagnosis since there is usually not sufficient damage to the eye blood vessels to cause them to be at risk for damage from fast improvement. In those with very poor control for long periods of time, improvements should be more gradual just because of this known problem with the eye blood vessels. The one time that this does not apply is during pregnancy when the health of the fetus and the mother are more critical factors. But, close follow-up of the eyes in such circumstances allows for early intervention with laser therapy if needed. In your case, this is not the case and you would usually see an eye doctor at annual visits as long as there are no eye complaints. You should discuss these issues with your diabetes team so that they can clarify the situation more specifically.

SB