My son, who has had diabetes for almost seven years, has been on the insulin pump for almost a year with A1cs of 5.7-6.9. He has a some highs and a few lows (not too severe) at times, but overall is doing well. His A1cs prior to the pump were be 7.0-8.0%.

However, I was so sad after reading a previous question and answer. Like all people with diabetes, he has had high blood sugars at times. Should I worry about damage since even a blood sugar over 200 mg/dl [11.1 mmol/L] can cause damage? We do our best, and when I read the true picture of diabetes, like the answer to that question, it gets me a bit depressed for his future. There was a time he was on steroids, when it took us one day to get the blood sugars under control. (He was in the 300s [mg/dl, 16.7 mmol/L] with no ketones. How much damage can we expect from diabetes at his age?

Diabetes treatment, whether with a basal/bolus regimen or with an insulin pump, is still an imperfect treatment. Nobody can achieve 100% control of blood glucose swings since estimations of insulin absorption, insulin doses, food effects on sugar, stress, infection and all these variables together are imprecise. So, with hemoglobin A1c levels consistently below 7% you are doing an excellent job, particularly if there are no severe episodes of hypoglycemia.

Don’t be so discouraged, but keep your eyes and ears open for ways to get improvement. We know from the DCCT and from studies in Brussels and Sweden that the chances of severe problems in your child with such excellent A1c results are significantly lowered — even if not 100% preventable — and this is what you should keeping remembering.

SB

[Editor’s comment: In looking at the a previous question, I believe Dr Deeb is taking about overall average blood glucose levels as would be reflected in the A1c. Complications are related to chronically high blood glucose levels, not each and every reading.

As Dr. Brink has already pointed out, your son is doing extremely well, is right on target with his control, and you should be very proud and pleased. There are many people with diabetes have had far lesser success, and they are at great risk of developing complications.

SS]