My 22-year-old son has had type 1 for a little over five years. For the first 4.75 years, his A1c was always between 5.7 to 6.2. Over the past 6 months, we are seeing a trend where the A1c is now creeping up to 6.2 to 6.6. The endocrinologist has said diabetes is a progressive disease. Does this mean that the HbA1c worsens with time and that it becomes increasingly difficult to keep the blood sugars well controlled? Is the HbA1c more difficult to keep under 6.5 the longer that one has diabetes?

I think what the endocrinologist means by the diabetes being progressive is that there is progressive loss of the insulin-producing beta cells that make insulin. It has been shown that the diabetes is easier to control while even a small number of the insulin-producing cells are present, because they can still make insulin on demand. When the cells are finally destroyed by the underlying autoimmune process, there is absolutely no insulin on demand and the sugars go higher. This does not mean the sugars cannot be controlled, but it does mean that insulin adjustments need to be made. The other side of the need to improve blood sugar control to long-term, well controlled levels is the risk of hypoglycemia. This may be more problematic in the future and is something of which to be aware.

JTL