My daughter was diagnosed last October. She is going to be five years old in February 2007. She had a three month check-up early this week and her A1c was 5.6%, which seems very good. This included the first one to two weeks after diagnosis when she was very high. I asked the doctor her opinion on such an A1c. She said it is quite a usual value. What is your opinion? My understanding of the A1c is that it is an average of blood sugar over last three to four months. Is it only an average or something more?

Another question I have is related to changing the Humalog to NovoLog. We use syringes currently but would like to switch to pens. My daughter is on very tiny doses, 0.5, and the pen from NovoNordisk has 0.5 units. We would like just to see if the pen works better than syringes from the point of convenience. Can she take Humalog in the morning and NovoLog in the evening or is it not possible to mix up the same type of insulin in one day?

The A1c is only part of the management, especially for a five-year-old. It is a measure of the average blood glucose, likely, not really three months, but a shorter period. What are the measured glucoses? What is the average? Does your daughter have many lows, etc.? It provides context. At 5.6 in a newly diagnosed, it probably represents a lot of insulin still being produced in the pancreas. If there are lots of lows, it may be too low; again, it represents an average. Diabetes management must take all these measures into account.

As to insulin, why would you want to pay two co-pays or buy two? Both of the insulins are quite expensive. If you want to use a pen, then the half unit dose for the NovoPen Junior is nice. Pens are a convenience item and the child isn’t giving insulin. The pen is nice for travel, school, etc. Then, it’s likely she isn’t doing either. Nevertheless, they are more convenient. You must be careful to let the pressure balance and count to let all the insulin be injected, especially with the small doses. A drop is a lot to miss. Your educator can explain..

LD

[Editor’s comment: While the A1c may be described by many as a measure of the average blood glucose, technically, the A1c is an arithmatic mean where the most recent glucose levels impact the glucose levels more strongly than those that occurred distantly. The A1c reflects about 120 days of blood glucose levels. It is my understanding that each time one’s blood sugar is higher than 150 mg/dl [8.3 mmol/L], the red blood cells will absorb the glucose causing the A1c to go up. This elevation remains until the red blood cells die, in about 120 days. Low blood sugars will not make that elevated A1c go back down.

BH]