July 5, 2000
A1c (Glycohemoglobin, HgbA1c)
Question from the Bronx, New York, USA:
My 8 year old son who has had Type 1 diabetes for three years. His hemoglobin A1cs have been 5.6, 5.9, and 6.4 for the last three years. Recently, it was 6.9. My goal is to always try to stay no more than 7. Can you tell me how his A1cs are affected? Is it always the high sugars, or can frequent lows contribute to a high A1c? He has them done every six months. What is the safest way to keep a normal reading for an 8 year old?
HgbA1c is a test that reflects the average blood sugar over the past 2-3 months. As a child has diabetes longer, his pancreas usually produces less insulin, so control becomes harder. Also as puberty approaches, the hormones of puberty make control harder, so that it becomes unrealistic for most children and teenagers to expect that they will have a normal hemoglobin A1c (unless they are having a lot of low blood sugars which will lower the Hemoglobin A1c).
Keep in mind that only 4% of the adults in the “intensive” control group of the Diabetes Control and Complication Study (DCCT) were able to keep their HgbA1c in the high normal range (and on an average, the adolescents in the “intensive” control group ran 2% higher than the adults). Also, after the study ended, the average hemoglobin A1c went up approximately 1% in the “intensive” control group. The incidence of serious low blood sugars (unconsciousness and coma) increased as the hemoglobin A1c decreased.
I think it is important to just try your best and help him keep his meter blood sugars as close to normal as possible, while trying to avoid serious low blood sugars. Also keep in mind that every day more progress is made towards developing newer insulins, better insulin delivery systems, better monitoring devices, and yes, hopefully even a cure.