My seven year old son, diagnosed at age four, has good, but not tight, control on a two shot per day regimen. His highest A1c reading to date has been 7.2%, and his endocrinologist (not a pediatric endocrinologist, since none are available where I live) is quite pleased with his control. However, high blood glucose readings as much as three hours after eating (usually after lunch) are not unusual for him, but return to normal as the day progresses. I hesitate to switch to tight control for two reasons: the quality of my son’s childhood being the first, and a couple of ugly experiences with low blood sugar reactions being the other. At what age does “tight” — rather than just “good” — control become imperative for children with diabetes?

It isn’t really possible to answer your question specifically. For one thing there is no accepted definition of what is ‘tight’ as opposed to ‘good’: More importantly, there are constant changes in the patterns of care that affect long term outcome. For the time being, I think it quite reasonable to accept an upper level of hemoglobin A1c of 7.2% as very good care for a seven year old and to defer for a time any move to intensive care in deference to quality of life considerations.

In the long run though, if transplant technology or advances in genetic engineering and stem cell tolerance don’t provide a cure, I am sure that you will want to move on to a regimen that is going to be more flexible for the teen and college years. This may involve a pump or perhaps the use of bedtime Lantus (insulin glargine) for basal needs with Humalog or Novolog in a variable dose just after the meal to adjusted for pre-meal blood sugar, appetite and the number of ‘carbs’ consumed.

DOB