My seven year old son has been on the insulin pump for about five months, his first A1c since starting was 5.7% and his meter average was 124 mg/dl [6.8 mmol/L]. We are very happy with the results! However, his doctor thought that too low for a child. Our son did not have any severe lows as we test eight time per day, and he ran almost near normal during the summer. We always check him at 11:00 before we go to bed., we do checks in the middle of the night which are usually in the low 120s mg/dl [6.7 mmol/L], and his fasting blood sugars are 78 -130 mg/dl [4.3-7.2 mmol/L].

What are we doing wrong? Why would his doctor not cheer about the 5.7% when we are not having lows, and he really is responding well to the pump? What is an acceptable A1c? We put a lot of time, diligence, and thought process into the pump which included detailed notes about food, boluses, injection sites to better help us get good numbers.

I think you and your son are doing wonderfully! One of the values of continuous subcutaneous insulin infusion (insulin pump therapy) is that it can smooth out the highs and lows, just as you’ve described. One can also really titrate the insulin hour to hour!

So why is your doctor not thrilled? I’m sure s/he is thrilled, but in fact, worried about “too tight control.” DCCT. showed us that there is a three-fold increase in significant hypoglycemia with intensive control, so I guess your doctor is being cautious. In most labs, the general normal value for the hemoglobin A1c is about 4-6%, so having a 5.7% is terrific, and, based on a “quick and dirty” converting formula suggests an overall glucose value of 104 mg/dl [5.8 mmol/L]. Remember, your meter is just giving you the readings from those specific time points! If you check eight times a day, that’s about eight minutes a day, but there are 1440 minutes in 24 hours. So a value of 104 mg/dl [5.8 mmol/L] relative to your meter average of [6.8 mmol/L] is really right on!

Finally, remember that there are two ways to get a “good” HbA1c: lots of highs and lots of lows, which average out or more steady normal levels. I think your son has the latter. I say: Keep up the great work, — but be very careful and prepared for lows. Make sure your Glucagon Emergency Kit is up-to-date!

DS