My nine year old daughter has had type 1 diabetes for almost five years. Her sugar levels, per her A1cs have always been in the 8 to 10.0 range. I am always surprised by these numbers as, in our opinion, her numbers have been good, very few lows and highs with daily averages in the 130s to 150s mg/dl [7.2 to 8.5 mmol/L].

I am tired of hearing doctors and nurses say “she is just a difficult child to control” without any positive feedback as to what we can do better to get those A1cs in a better range. She was on the pump for two years and we had to discontinue use because her numbers were getting worse, not better. Currently, she is on five shots per day, Lantus and Humalog in the morning, Humalog at lunch, and both Lantus and Humalog at dinner. In addition to that, if she wants any snack greater than 12 grams of carbohydrates.

Do you have any suggestions for me?

The answer it’s not easy indeed. Many things need to be balanced to keep the blood glucose steady and then to get good A1c levels. It is very likely that the higher than expected A1c values might depend on nighttime blood sugar level fluctuations not recorded by daytime home self monitoring. Moreover, it isn’t easy in a child to make all the pieces fit and many times it’s difficult to figure out what actually went wrong. As a parent, it’s very important that you get used to, as early and as best as possible, handling your daughter’s diabetes. This is to better understand the different ‘why and how’ in order to be better prepared to meet different situations in life and to teach your daughter how to take independent responsibility for her diabetes at the time she’s about to enter puberty. That’s a very difficult period of life for metabolic control. I would suggest that you, if you haven’t done so yet, ask for the nearest pediatric diabetes team to work with.

MS