Justin Delgado is husband to Kacie Doyle-Delgado, diagnosed at age 11. After more than a decade together, he considers himself to be an expert carb counter and Dexcom inserter. He graduated with his Master of Science in Finance from the University of Utah in 2013 and has been working in commercial banking since then. He attended his first Friends for Life conference in 2015 and is looking forward to volunteering with the teens.
June 26, 2000
A1c (Glycohemoglobin, HgbA1c)
Question from Franklin, Virginia, USA:
My son was diagnosed with type 1 diabetes about a year ago. He is now 2 years old. He just got his first lab results back. His A1c level was 10.6%. My endocrinologist doesn't seem to be concerned about that, but I am very worried. What is a good level for a toddler? What can I be doing to make sure it is lower next time? Isn't 10.6% a pretty high level?
Mood and appetite are so volatile in a two year old that meticulous control can be very difficult. An A1c of 10.6% would certainly be considered high nowadays in an older child; but I suspect that the endocrinologist may have been deliberately reassuring because he felt it was more important at this time to keep very clear of severe hypoglycemia than to achieve more perfect control.
There are two things that you might talk to him/her about. The first is whether Humalog insulin might be a good idea. Its great advantage is that it starts to act very quickly and so the injection can be deferred until after the meal has begun and the dose consequently adjusted for the pre-meal blood sugar and for appetite. It would however mean an extra insulin shot at lunch time unless you could work out a mixture of Humalog and NPH insulins for the morning dose that ensured sufficient mid-day coverage. The second would be to develop a rather detailed profile of blood sugars throughout the day. This should give you an idea as to the extent to which changes in activity, stress and variations in food intake can affect blood sugars. As part of this it would be important to do an occasional test in the middle of the night.
Armed with all this information you might be able to devise a better regimen of insulin which would still avoid hypoglycemia and thus lower the A1c without risking hypoglycemia.