My daughter was diagnosed at the age of 3 1/2 yrs old, two years ago, and her last two A1c levels have me concerned. They were 9 and 9.6 in a 3 month time span. The primary doctor that saw my daughter just last week also questioned me about this. He said that these numbers mean that her sugars have been averaging over 300 mg/dl [16.7 mmol/L], which concerns him. He said that, over time, this can cause damage to her body/organs. He said we need to get her sugars under better control. I am now second guessing the endocrinologist. I don’t know whether to go for a second opinion or not. My daughter’s well-being is my main concern and I’m wondering why the endocrinologist hasn’t picked up on this. I’m fairly new to this diabetes stuff and not sure if I should change doctors. We are constantly counting carbohydrates and making sure she is consuming a healthy diet. Since she was diagnosed, we have changed the way we eat, especially eating low carbohydrate items. What do you recommend?

Your PCP (primary care physician) is correct that the A1c levels you report are very high. The average sugar level, however, is closer to 212 to 230 mg/dl [11.8 to 12.8 mmol/L], not 300 mg/dl [16.7 mmol/L], but still too high. It is surprising that the diabetologist is not concerned so I would usually recommend that you make an appointment specifically to discuss this with your diabetes team and see if there is some misunderstanding of goals. Sometimes there are psychological barriers to improving blood sugar levels that need to be better addressed. Asking exactly the same questions to your diabetes team that you and your PCP have been discussing is okay to do. It is best to bring what we call a profile of pre-meal and 1 to 2 hour post-meal blood sugar levels for about two weeks to review since that can help with treatment options to be considered. Usually there is some problem with excessive hypoglycemia, hypoglycemia unawareness or hypoglycemia fears when such high A1c levels persist. If there is still a problem with different goals, then going for a second opinion would be quite reasonable, of course. Adjustment of carbohydrate counting, blood sugar target goals, multi dose insulin regimens or pump treatment are all viable options to consider.

SB