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Frequent Responder
renasam
Total Posts: 106
Registered on: ‎11-04-2009

A1C 7.7!

We've been feeling pretty good lately about Sam's numbers..... we've lopped off the crazy high's, lopped off the crazy low's and we feel like his variability is much improved! So imagine my chin, and my husband's chin on the floor of the diabetes clinic when we heard Sam's A1C is 7.7, up from 7.3! We haven't slacked off, we count carbs dutifully, we've mastered dose adjustments for exercise, we rabidly read anything that will improve the quality of Sam's life, and we react. We test often, we do everything, and I mean EVERYTHING to improve Sam's control!

When we got home from the appointment, I cracked open the Bayer A1C Now package and tested at home. It registered 7.9, so no consolation there. The endo is still pleased with 7.7, but I am not a peace with it!

What am I missing?
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Mainecat
Total Posts: 22
Registered on: ‎11-01-2009

A1C 7.7!

I am sorry to hear about Sam's A1c going up - despite your hard work... I know how bad that can feel. About a year ago my son's A1c did the same thing - our Endo was still pleased with the result but we weren't... When we continued to push for answers the nurse told us that his previous A1C was probably falsely low because of the wildly swinging blood sugars. So we continued to tweak and our next A1c was one of his best - no real high or low blood sugars. Of course now he's 18 and has a girlfriend that often distracts him from testing so his A1c has started to creep up again.

Good Luck and hope that the A1c is better next time, for now all I can say is I'm sorry and keep up the good work....

MaineCat out.
Occasional Contributor
Alexsmom
Total Posts: 252
Registered on: ‎11-02-2009

A1C 7.7!

I think MaineCat is right. When you got rid of the wild bg swings, you got rid of a bunch of lows that were bringing the a1c lower. So while the a1c seems worse, it's probably better overall b/c the swings are not there.

You're doing the best you can. Just keep plugging away.....
Barbie,
Mom to Alex, 21 yo, T1 dx at 15 yrs
and Neal, 13 yo, non D
Super Advisor
deafmack
Total Posts: 2,527
Registered on: ‎10-31-2009

A1C 7.7!

Hi Rena,
Sorry about the increase in the a1c. It could be because of the decrease in the highs and lows and more stable numbers. One thing that I learned about is a thing called Standard Deviation. You can read about it at this link.
www.diabetesmonitor.com/m57.htm
There is an online calculator to figure standard deviation at this link.
http://invsee.asu.edu/srinivas/stdev.html
Irl Hirsch is a big fan of Standard Deviation. From what I hve read, Standard Deviation gives one a better picture of how one is doing than the a1c.

a Deaf person with Diabetes.

Frequent Responder
renasam
Total Posts: 106
Registered on: ‎11-04-2009

A1C 7.7!

Thanks everyone for your words of encouragement! The fact that Sam's variability is improving is worth celebrating, even though I don't think that's a result of anything we've done; his body just happens to be cooperating at the moment.

Deafmack, thanks for mentioning Dr. Hirsch. I had completely forgotten about a conversation DH and I had with him last summer..... he said too much emphasis is placed on A1C. He said the only reason he tests A1C is because insurance companies/Medicare require it. He's more interested in 1) blood pressure, 2) whether the patient is on a statin, and 3) the lipid panel. (Bear in mind he's not a pediatric endocrinologist.) He also said the GlycoMark (measure of variability) will probably become the standard of care, in conjunction with the A1C. He was very reassuring. I can't believe I had forgotten that entire conversation!

So yes, we'll keep plugging away and be thankful for all the resources we have.
Frequent Advisor
gsmom1
Total Posts: 376
Registered on: ‎11-03-2009

A1C 7.7!

I think we will be right there with you this time. Almost 2 years since diagnosis, high school, growing you name it. We have not changed what we do, but sure are chasing the numbers.
G 18 diagnosed 3/22/08
Contributor
slpmom2
Total Posts: 236
Registered on: ‎11-05-2009

A1C 7.7!

Hey, Rena -
I'm sorry you were hit with a surprise A1c. That must have been so discouraging. BUT... I think DeafMack and the others who have already posted have hit on a huge point, which is reduced variability. That's so much harder to achieve sometimes than the good BG, but is being recognized more and more as a really important factor. You know that you and dh have been doing everything you can, and that's why you've been successful in reducing the variability. Pat yourselves on the back! Sam is still in the range he should be in, and he's very lucky to have parents who are willing and able to work so hard on getting his control better and better. And we all know that just when we think we've got a grip on things, D comes and bites us on the butt again, just to remind us that we're not in control (see my follow-up post on dd's endo appointment, and you'll see that we've just had our reminder, too!).

Hang in there!
Occasional Contributor
Ethanator
Total Posts: 40
Registered on: ‎11-24-2009

A1C 7.7!

Oh Crud Rena......

Sorry. I can say....with confidence that NO ONE I know works harder at this than you. (Sorry JoAnn you are a close second) You are a force to be reckoned with as D care goes. You are diligent without being obsessive and your son has a great grip on all of this, makes good decisions and those are things you need to focus on and be proud of......really proud of. Long term those are the tools you need to give your kid. So please don't let one a1c get you down. What has been posted makes total sense number wise, but you gotta know that those a1c's are gonna come.....for their entire lives. It is just the nature of this disease and moving forward with that disappointment in hand and a smile on your face is the best lesson for Sam.

I will add that we went from a glorious 6.4 to a not so good 7.4 at our last two endo appt. I can tell you the next one is anyones guess. His numbers were great in Costa Rica and have been horrific......so high we are getting ketones, since we returned. I am trying to use this as a reason to return to CR but Pete thinks we can just adjust basals......bummer.

Last of all........I consider you a role model in D management. I know you work very hard and worry a lot, but it does not seep into your son's psyche.....so you are balancing it all very well. So hang in there and be proud of all the good things you are doing. It is just a stupid number afterall that really reflects a moment in time......

Lieschan
Lieschan

Mom of Max now 14 and Ethan 11, DX 11/04/07, pumping with Animas 3/08, Dexcom 7, 9/11
Frequent Responder
renasam
Total Posts: 106
Registered on: ‎11-04-2009

A1C 7.7!

Gosh, I'm so glad that this board's most prolific poster is back in town! Thanks, Lieschan, for your pep talk. I'm hanging on to every word.

Of course I'm still wracking my brain trying to figure out where there's room for improvement (you can't stop me!), and the only thing I can think of is more CGM use. Sam hates it, and it really beats up his skin, as well as the tissue underneath. I wish he would beef up a little and give us a few more options for insertions.

He's due for a new pump next year, and he really wants to go tubeless (Omnipod). Since this is the pump that's going to take us through puberty, then I really want CGM, so I hope Omnipod releases their Dex-integrated pump soon....... of course I'll want to do a saline trial myself, as I am very partial to Minimed.

Thanks again everyone for the words of encouragement. Our endo is great, and we get a lot of support in that regard, but it means a lot more to hear it from folks who are in the trenches.
Established Advisor
katies_dad
Total Posts: 412
Registered on: ‎11-08-2009

A1C 7.7!

Hi Rena,

I agree with the others that the redcution in lows could be resonsible for the increase. Especially if you were having more lows than highs and then brought it in line.

In terms of scale, a 7.3 is ~ 183 mg/dl and 7.7 is ~197 mg/dl. It really is a small change, and if you put into context of everyday management you (probably and us for sure) live with +/- 50 from target pretty regularly.

I do have another thought. It seems like in a previous exchange you noted that you use the "combo bolus" (or whater its called for minimed) quite a bit. Depending on the food and the split (40/60 , 50/50, 60/40, etc) you could be having some post meal highs and still be getting back to target 6 or 7 hours later when the combo's effects are fully completed. If you have a GCM (we don't) then it should be pretty easy to track. Our trainer told us we should never see a 200 when on the pump (she would be very dissapointed in us) when all the settings are right.

We too say Katies A1C go up about .5 from the last appointment. Her issues are with a growth spurt and we have chased and chased to get everything back in line. In the end, she now gets nearly 25% more insulin than she did just before Christmas, but her numbers are decent again.

Which reminds me. At home, we give Katie a good lead on her food with the insulin. We can't do that at school. We don't get a 2 hour post meal check, but if we did I'm pretty sure it would be stupid high. She tends to come home from school high (nearly 200), but on weekends the same ICHO leaves her either spot on or just a bit low. Its that deal about taking 3 times the insulin to bring down a high as prevent it.

That is just my long winded explanation of why A1C's will go up as school starts even if everything is still perfect.

Good Luck and God Bless,

KatiesDad

Katies Dad

Katie diagnosed T1 July 2008, pumping with Animas Ping since June 2009.