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January 29, 2001

Tight Control

Question from Virginia Beach, Virginia, USA:

My 10 year old daughter has had type�1 diabetes for five years. Her A1c has usually been in the 7-8% range with the most recent one being 5.9%. Our pediatric endocrinologist feels this is too low, and we’ve always been told previously to shoot for 5.5 to 7.5%. Is this too low?


From: DTeam Staff

The beauty of the HbA1c test is the benefit of getting an overview of glucose values for the previous four to six week time period. Previously, we felt the hemoglobin A1c represented closer to three months, but more recent analysis suggests a shorter time period. If the value is below 6%, in my experience, it is likely there are significant periods of hypoglycemia, often overnight without being awakened by symptoms, and sometimes at other times as well. So, a “too low” A1c suggests the need to increase food, decrease insulin, or make appropriate adjustments after detective work to see where the hypoglycemia occurs.


[Editor’s comment: Your daughter’s situation might well be clarified by monitoring sugar levels continuously for several days to try to sort out what’s happening in more detail. See The Continuous Glucose Monitoring System, and ask her endocrinologist about this.