My 10 year old son has been on insulin since the age of two. His hemoglobin A1c is now up to 8.3% and I’ve been told it needs to be 7.5%. We are now carb counting to try to lower it, but his blood sugars are still erratic and hard to control. I worry about his long term health, should I? Any ideas that would help us manage him better?

The best way I’ve found to really tighten up control of blood sugars is to make frequent adjustments to insulin dosing. Carbohydrate counting will likely give you the best results. I would suggest keeping good records and reviewing them with a knowledgeable person on your son'[s diabetes team each week until you are seeing the results you like. You and your son might also consider an insulin pump. This is more work, but offers a better chance to micromanage diabetes and lower your son’s hemoglobin A1c.

Also, have realistic expectations. You will never be able to eliminate the erratic days completely. A good goal is to work hard to minimize the number of highs, lows and erratic days.

MSB