October 15, 2002
A1c (Glycohemoglobin, HgbA1c)
Question from San Antonio, Texas, USA:
Our not quite two year old daughter’s first A1c was 8.8% (four and a half months after her diagnosis), and we thought we had been doing better, so we were not pleased with this result. The endocrinologist told us anything under 9.0% was acceptable and not to worry about it. The CDE was trying to find room for improvement using our daily logs until the doctor said not to worry about it.
She had been Lantus (insulin glargine) in the evening with Humalog after meals to match carb intake, and we noted a pattern of high blood glucose until right before the pre-meal reading. Essentially her blood glucose was out of range (over 200 mg/dl [11.1 mmol/L]) almost all the time, except just before meals. We decided to switch to pre-meal Humalog, and her blood glucose seems much more even and in range for longer periods of time, with very few hypo incidents since then as well. Should we be concerned about the 8.8%? Any other suggestions for improvement? Is the first reading usually higher as the family learns how to manage diabetes?
Answer:
It can be very difficult to get tight control in a young child, and there is evidence to suggest that too tight control is not beneficial, as the child is more at risk of hypos. I would have thought an hemoglobin A1c of less than 9% is very acceptable.
Giving Humalog before meals is preferable, if you can be sure your child will eat the meals. Sticking to a reasonably stable and regular diet will also help. It sounds as though you are doing very well. Keep up the good work.
JS
[Editor’s comment: Sweet Kids: How to Balance Diabetes Control & Good Nutrition with Family Peace by Betty Brackenridge and Richard Rubin a great reference for managing a toddler with diabetes.
SS]
