December 8, 2004
A1c (Glycohemoglobin, HgbA1c), Hyperglycemia and DKA
Question from South Lake Tahoe, California, USA:
My 14 year old son seems to be taking more and more insulin in his teens. The addition of metformin to his daily medication has been recommended by a highly respected parent and director of “Children with Diabetes.” However, our endocrinologist does not feel he is insulin resistant until he is taking more than 160 units of insulin daily. Our son is about 5 feet, 7 inches and weighs about 135 pounds. He takes about 75 or more units of NovoLog and 28 units of Lantus per day. His average blood sugars are in the 200s mg/dl [11.1 up to 16.1 mmol/L] with an A1c of 11. Since diagnosis about three years ago, he has never had an A1c less than 10.0.
What are the average amounts of insulin taken and A1cs, typically, that key a physician to add a drug like metformin to a teen’s daily medications? If watching one’s diet, exercising and being diligent about taking blood sugars and injections are not enough, what else can be done to keep in better range and health?
Answer:
These are very high A1c levels and suggest that your child is at risk for long term glucose related problems of such out-of-control diabetes. What does your diabetologist suggest to try to bring the A1c values closer to 7%? The actual insulin doses are high but not so inconsistent with other teenagers. Sometimes insulin resistance in puberty can be treated with some oral hypoglycemic agents like metformin, so this is not so unreasonable to at least consider. The key issue, however, is why the hyperglycemia persists even with such doses? Omitted insulin? Sloppy timing? Food problems? Alcohol? Drugs? Depression? Other psychosocial problems? I would go back and discuss all this with your diabetes team in great detail.
SB
