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April 13, 2002

Daily Care

Question from Pittsburgh, Pennsylvania, USA:

My daughter, who has had type 1 diabetes since the age of 19 months, had an A1c of 10-11% at that time, and now, 15 months later, it is 6.3%! However, her endocrinologist advised that this is too tight, running the risk of a severe low causing possible seizure. If 6.3% is normal, then why would she be at risk for this?

Answer:

In the case of an older child, a hemoglobin A1c of 6.3% would be a great goal. It reflects an average blood sugar of around 130 mg/dl [7.2 mmol/L] over the past three months. However, in toddlers (I believe your child is somewhere around three years old now), a good goal of blood sugar control is to avoid lows, avoid dramatic highs, and avoid hospitalizations. Aggressive care aiming for an A1c less than 7.0% is probably not the best idea in your child’s age group. I believe her endocrinologist’s concern is simply that lows may be happening without your knowledge, and having a hemoglobin A1c of 6.3% may run the risk of severe low blood sugars.

MSB