Sugar’s current A1c history… 7.5%
So…did you hear? Last week, at the American Diabetes Association 74th Scientific Sessions, the ADA announced that they are setting a new A1c target of less than 7.5% for children of all ages.
Oh wait…let me back up…
Hello! I’m Wendy.
Wendy Rose www.CandyHeartsBlog.org
I used to be an avid blogger in the Diabetes Online Community, but my life derailed about a year ago and I’ve fallen off the edge of a cliff. (Not literally, of course. But whatever. We can get to that later…maybe.) At any rate, *NEWSFLASH* — during my hiatus, my daughter’s diabetes hasn’t gone away. Nope. Not even a smidge. So, even though my online presence hasn’t been as active as it once was, I’m still paying very close attention to things like, say, the ADA making an announcement like this.
Why you ask?
Well, basically because it means my daughter’s A1c of 7.5% just went from being comfortably in the center of her target range to, suddenly, being above target, when you consider the wording used by the ADA:
The Association now recommends that children under the age of 19 diagnosed with type 1 diabetes strive to maintain an A1C level lower than 7.5 percent.
Did you get that?
“LOWER than 7.5%”
Which means our comfortable 7.5% is not lower than 7.5%…which means, at 7.5%, it’s no longer comfortable.
But I’m not stressing.
Okay, maybe I’m stressing a little…but not because I’m a perfectionist with a Type A personality. It’s not what you think. It’s not about self-loathing, or beating myself up, or seeing that number as a report card.
It’s because I know how much work it takes to achieve this, ehum, *UN*comfortable 7.5%. And I know how much work it’s taken to keep her between 6.8% – 7.5% for the past seven years.
I also know how hard it was before then, too. For the first 2 years of Sugar’s diagnosis, I couldn’t drop that number under 8.0% to save our lives. You see, she used to have horrible low blood sugars that caused her to pass out and hit her head at least twice a month, with stretches of once or twice a week. It went on for about 2 years…and it was terrifying.
Look, when you need to give 1/4u or less of insulin, but only have a half-unit marking on a syringe (at best), making sure you’re giving the correct dose of insulin is a constant guessing game. 1/4u of insulin made a huge difference to my daughter, and the smallest deviation in either direction made a big impact too. We couldn’t avoid those terrible lows without dealing with terrible highs.
(Sidenote: “High frequency of and early exposure to severe hypoglycemia during development negatively affects spatial long-term memory performance.” HERE‘s the study.)
So, here’s the thing: I’m all for this tighter target…but something has to be done to accommodate the unique needs of children dependent on insulin.
T1D is on the rise globally at a rate of 3-5%/year. The majority of those affected in this increase are kids under 5. If the rapidly growing brain of children under 5 years old are expected to achieve less than 7.5%, then a few things need to happen…
* Micro-dosing via syringe is a must. This could mean that pre-filled diluted insulin syringes need to be made available. Both syringe and pen manufacturers are going to have to rise to the challenge so that the tiniest of doses can be administered safely.
* ALL pumps need to offer even smaller dosing increments.
* ALL pumps need to offer the option to program a zero basal at times (my daughter needed zero basal between 12 am – 2 am for a long time. I shouldn’t have to get up and set a temp basal every night. It should be an automatic option). On that note, ALL pumps need to offer even smaller basal rates.
* Teaching about the correct timing of meal boluses is necessary. Stop telling parents that it’s okay to bolus after a meal. No. It’s not. Not if they need to achieve an A1c of less than 7.5% for optimal decreased risk of long term complications. How do you safely pre-bolus a picky toddler? It might mean parents need to start by giving half the meal bolus up front and the other half after the child finishes…which would also mean 2 shots at every meal instead of one. It might mean parents are prepared to use juice or milk or something else to make up the difference if said picky toddler doesn’t eat enough carbs to match the insulin that was already given. These are hard rules to implement, but less than 7.5% in a growing child isn’t a cakewalk.
* Overnight checks and corrections are necessary. In fact, here’s an excerpt from the new ADA Position Statement regarding the recommended times patients with T1D perform Self-Monitoring Blood Glucose (SMBG)
There it is: “MIDSLEEP”. Yes, that means parents need to get up to test their children at night. And, if they need to give a correction, that means they need to get up a few hours later to test them again to monitor for hypoglycemia. Gone are the days of letting your little run a tad too high as a trade off for a good night’s sleep. Less than 7.5% doesn’t allow room for that. Which brings me to my next point…
* Parents need faster access to a CGM. These little people are physiologically too small to carry on a 2 way conversation, let alone possess the ability to verbalize what they are feeling and alert someone when they need help. I wholeheartedly believe that I would have been able to catch most, if not all, of those horrible lows with a CGM. (Except that it didn’t exist, and was hardly accessible to the pediatric population when it did.)
Now, listen. If your kid is pushing a 9% or higher, I’m not here to berate you. And if your kid is cruising along at 6.5%, I’m not here to make an example of you. I’m here to say that I believe parents (and kids) WILL rise to the challenge, but technology and education will have to evolve to support the effort.
We’re in this together, my friends.
Keep swimming…and striving for less than 7.5%.