Wednesday, February 2, 2011

A1c Sauce

Every time I hear "A1c" in recent weeks, it makes me think of Caleb from "This is Caleb"  Caleb's mom, Lorraine, posted a video of Caleb on her blog and he told this joke (I'm paraphrasing here...)

"What does a person with diabetes put on his steak?"

"A1c Sauce!"

I think that's hilarious!  Apparently, I'm down with 7 year old humor!  I find it to be a refreshing change from 5 year old humor - which is really just saying 'underpants' and then laughing hysterically.

Speaking of A1c.....

Back in the fall, we went to our quarterly Endo appointment. 

We were pleasantly surprised with an A1c of 7.5.  Sweetpea has been steadily decreasing since dx.  Here are our A1c results:
April 2009 - Diagnosis:  12.5
May 2009 - 10.2
August 2009 - 8.5
November 2009 - 7.9
March 2010 - 8.0
June 2010 - 7.6
September 2010 - 7.5


It was also time for her yearly blood draw (aka arm draw..... aka extreme horribleness).  I decided that even though her Celiac screen was normal last year that we would go ahead and add it to the panel.  Just to be safe.  I wouldn't worry so much if it wasn't for the MAJOR constipation issues she has.  Issues that started at the same time that D entered our lives.  And yes, I know that Celiac is usually linked to diarrhea.... but not always.  And why not just go ahead and do it if we're getting blood drawn anyway?

So we did.

It was unfun.  Sweets detests arm draws.  Even though we numbed her up and promised her Chocolate Chip Pancakes after!  But she did pretty well and the nurse was AWESOME so it wasn't as awful as it could have been.

The results came in....  Negative again.  So I feel like I can relax a little about that.  Plus her constipation issues (or poop issues as she calls it) are getting better.  Praise the Lord!

We went back to the Endo in January. 

I was seriously worried about this one.

Part of it was due to the string of highs we had that were associated with the bad sites that landed us in the hospital on World Diabetes Day.  I couldn't help but wonder what all those bad sites and high bg's had done to her A1c. 

I was a bit obsessed.  I remember being IN THE HOSPITAL and thinking, "Well, Hell.  There goes the A1c." 

I was checking our averages rather often.

It was not pretty.

But.... as the saying goes.... one high number does not an A1c make.

And her A1c in January was.......   7.1%

WOOT!

I was thrilled! 

Until.....

Our wonderful Endo is out on maternity leave.  *sob*  So we had to meet with a different person this time.  And she totally stole my A1c joy.

She thought that her A1c was too low. 

She thought that Sweets had been having too many lows.  And that "anything under 8.0% is considered good for her age so 7.1 is a little low."

Hmph.

So I immediately began to worry that I was depriving my growing child of the sugar she needs to function and grow.  I pictured her little brain gasping and struggling to function.  It was sad.

Reyna over at Beta Buddies posted this chart on her blog today:

The American Diabetes Association has the following A1C recommendations for children and adolescents with diabetes:


Children younger than 6 years old - 7.5% to 8.5%
Children ages 6–12 years old - Less than 8%
Teens ages 13–19 years old - Less than 7.5%

So....  I suppose it IS a bit low.

However, an A1c of 7.1% is approximately equal to an average blood glucose of 176.  Sweetpea's target blood glucose is 150.  So it's a bit confusing.  How can an A1c that correlates to a bg level that is 26 points HIGHER than her target be too low?

I realize that a higher A1c that is achieved with less ups and downs shows better control than a lower A1c that is achieved through multiple lows.

And I do recognize the need to reduce the number of lows. 

As I see it, it's a work in progress.  Getting the Dexcom allowed us to be more aggressive.  Being more aggressive means (for us) prebolusing meals, making more changes on our own, and running her lower at night (being comfortable with a number between 100-150 instead of preferring a number between 150-200).  Inevitably, this leads to lows as you are figuring out the perfect balance. 

I also recognize the need for ME to be ok with how we are handling her care. 

I need to be ok with these numbers regardless of what a doctor or a chart tells me. 

And I am.  I know that we are doing everything we possibly can to manage her diabetes and tighten our control.  God knows, we're not perfect.  But we're trying. 

And as long I know we're giving it our all...  I'm ok with whatever number pop up.

Pretty much...!

(I decided to put The Gambler at the top of today's playlist because that's what we do with numbers... it's a gamble.  No matter what.  And then Low Rider... because I thought it was funny!  Will close the play list poll down soon....)

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19 comments:

  1. When we had an A1c of 6.6, our endo was overjoyed for us. Because she knows that we are so vigilant in Elise's care. She did not admonish us about missing lows, because she knows we check Elise often enough. I guess what I'm trying to say is that this doc doesn't not know anything about you. She does not know what amazing care you take of Sweetpea. I'm of the opinion that HER opinion doesn't count for all that much.

    I think you're doing a great job and don't let her steal your joy

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  2. Thats an awesome A1C!! Own it!!

    With that said you know if its due to lows or better control, dont let her rain on your parade or in this case pour ketchup over the a1c sauce? ;)

    xoxo

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  3. I didn't know about kids A1C's being higher. So, now I don't have to kick myself - as I'm sure I was up in the those areas thru' my years from 6-12. Remember, for this old fart diabetic of 43 years, A1C's only came about in the late 80's. It was just urine testing and 1 needle a day. The good thing? I'm doing GREAT! Hopefully the same will happen for your little Princess! Just come to me when she hits teen years - boy oh boy - I was a terror - but a nice one \\^^// - my Mum was such a saint to put up with a independent D-daughter like me :)

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  4. you know you rock and you are doing an awesome job :) you know that our (CARA'S) A1c completely sucked this time around...you can never win!! so just don't let yourself play the guilt game!! It is what it is as long as you are doing right for little sweets...which you are!! xoxox

    and I'm sorry but I totally laughed out loud at the underwear joke...hahahah. Goes to show how grown up I am!! and I'm still smiling :)

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  5. I am with Jo...I don't think this Endo knows you well enough to make that comment. Our Endo was always ecstatic with Joe's A1C's in the high 6's. He actually seemed a bit concerned about the 7% we just had...wanting to make sure that it was a result of "boosting" for so much ice skating and hockey and not an underlying basal issue...made me feel a bit bad (not on purpose - I am sensitive when it comes to Joe's management).

    Anyway, what I am trying to say is I think you are doing fantastic D Mama...and I would like to know...what did you end up doing about the site issues? We are going to try a couple of different sites (the angled one and/or a 9mm one) b/c the insets (6mm) fail by hour 36...and Joe HATES (can't scream it loud enough) the Contact Detach sites.

    xoxo

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  6. I read this with great interest. So many of you moms are so involved so intricately with even the most minute elements of diabetes care! Since I'm a new d-mom, I'm still just trying to figure out good dosing. I'm not even thinking about A1C levels yet. We go for our first one next week, though -- so it's been insightful to read everyone's A1C posts as of late. I think our diagnosis was somewhere in the 7s, maybe 8. So, I'm really fascinated to see what we end up with...

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  7. Thanks for the sweet comments! And thanks for reminding me that I never posted about the "solution" to our site problems. I will - next post I do. After my VERY COOL giveaway on Friday! :)

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  8. HI FIVE, D MAMA!!!!!!!!!!!

    WOOHOO!!!!!!!!!! Love it :)

    Don't let anyone steal your joy...I'll have a little party over here for ya! Doing a jig right now :)

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  9. I say you are awesome. :) I say 7.1 isnt too low if she isnt having too many lows....but what do I know? ((HUGS)) I hope you see rainbows and butterflies with that a1c!

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  10. That's the exact same thing my endo told us with Parker. He was at 9.6 at diagnosis and 7.1 his one month check up. He really was too low because he is honeymooning, but we are so new that they seemed to think they had been giving him too much insulin. But I'm sure as long as you guys have been at it, it must be a reflection of diligent care on your part!

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  11. Its not your regular Endo, so who cares what they think? I bet your endo would be thrilled at how well your doing.

    According to that chart ours is way to low too. No worries... you guys are kick ass pancreas'

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  12. I personally would LOVE to see that A1C with Sugar Boy. We have the opposite problem. We have VERY FEW lows (I can count on one hand the number of times he has been under 60 in the last 3 months) but that means that EVERY high drives the A1C up. As a result our last 3 A1C's have been in the upper 8's. Which drives me nuts. Our endo is pleased, though, because we have avoided lows. *sigh*

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  13. Oh pooey. That's just crap.

    That's easy to say - 7.1=too low. But can only be said with the full picture and only you know that full picture Hallie. So while it MAY be true - gosh ANY (well maybe not any, but lots) of A1Cs can be comprised of huge swings between highs and lows - it may not be.

    I'm sorry she rained on your parade. Own it, like Lexxi said.

    Those ranges make me think of the Pink Panther Book. I've seen ranges like that. I don't think it's quite so black and white, particularly with the technology that kids have been using (which has exploded in just the last year).

    There's just too much to consider that makes a blanket statement of "7.1=too low" too simplistic.

    Caleb thinks saying "underpants" is hysterical too. lol Thanks for the shout out. :)

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  14. Just saw Reyna's post and the ranges are from the ADA. I still say you are both rockin' it. Truly. :)

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  15. Diagnosed at 8 years, prior to cgms being put in the market her pedi endo wanted A1c of less than 7 and prefers the mid-sixes. I realize your little one is younger and has a higher range. But I think A1cs in the 7s, when endo knows you have cgms, are not too tight. I don't think our endo likes anything higher than 7 period for ages 7 and up. You are right to celebrate; you are doing a great job. You cannot eliminate lows as she has D and you are dosing a moving target, constantly changing. There will be lows; there will be highs. As well as days of highs and days of lows. As long as you are attentive and on top of it. And you are. I'd take a 7 over an 8 any day!

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  16. I think I messed up my comment and it didn't go through.....

    Anyway, I think Sweetpea is blessed to have you taking care of her. You are watching closely and doing a great job!

    It's an awesome A1C!

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  17. Interesting info, Hallie! We have not had an A1c since the 11.9 in September for diagnosis. This info will be great for when we get ours in another month

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  18. Hmmm...isn't it interesting how all of the docs give different opinions and information. RED was a 10.2 at diagnosis (12/09)and we had her down to a 6.2 in about four months. Our endo thought that was great because she was still honeymooning and we are also super strict carb counters. In September she got her pump and then a couple weeks later her cgm. At her last appt. she was up to a 7 but the endo said that was because her lows were so drastically reduced that it was a truer number. Our doc told us that she would start to be concerned if we creep up to the mid sevens. I think it's all relative. You know you are doing a great job and have tight control so I say rejoice when you get such a great result :-)

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  19. Oh gosh-7.1 is awesome!! You should definitely celebrate! : ) It's cause you have a CGM and are working hard to stay on top of her blood sugars! : ) Pat yourself on the back, and consider it a job well done.

    Don't let stranger-doc pee in your Cherrios! Hooray for both of you! Holly

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