My feelings from the patient - caregiver perspective regarding the A1c hasn't changed since I wrote this article. If anything, the new ADA guidelines requiring pediatric patients to adhere to astonishingly low values of 7.5 or less, has further underscored the need to use a different metric to measure patient compliance/success. As a mom that diligently monitored blood glucose in toddlers (without an accurate CGM) through teens (with an accurate CGM), I can testify hormones can/will thwart even the most carefully laid out T1d plans. In the year since this article was written, without modifying her lifestyle, our oldest daughter's A1c has decreased to 7.2. The difference? She acheived what is most likely her adult height and her hormones have stabilized. Conversely, my youngest daughter, just two years behind her sister in entering the peak of puberty, hormones are surging and over the past six months, she has grown about 4-5 inches, to match her sister's stature. Her A1c is 7.8 and while we will attempt to combat it with multiple (and aggressive) pump setting changes, it will most likely increase a bit more before leveling off.
Unfortunately through that narrow clinical perspective of an A1c score, the true success is missed. My girls have missed zero days of school due to T1d, they stayed healthy through out the winter, in our 8 long years of T1d, they have never been through the ER and even more importantly, they haven't missed out on doing anything they wanted to do... which has included sleepovers, theater performances, field trips, concerts, movie nights with friends and even dances where mom did not have to chaperone.
A slightly higher A1c is exchange for a mentally healthy and well-balanced child is a risk that I am willing to take.
As a parent who is leery of over emphasizing the A1c (good or bad), I thought it might be interesting for you to know where my own two daughters fall into the scale of quarterly numbers.
Before I do, I want to clarify a few things.
As we all know, this is a variable number which is subject to change and does NOT account for much of LIFE. I want to demystify the idea that raising kids with type 1 diabetes should mean that we are "regulated" and have numbers in the low 6's.
There is no such thing as regulating a pancreas in a person living with type 1 diabetes.
Especially when that person is living in their own body (not yours) and is growing at the rate of 1-2 inches (sometimes even more) and gaining at least 1-2 pounds every three months. Dare I even mention the P-word? Oh my!
And did I explain that person is a child who is often being invited to birthday parties, holiday festivals and taste-testing their way through Costco? Heck, even the car wash dude passes out two lollipops to her just because she is cute? You don't think she throws those away, do you?
If you think those are excuses, well they aren't. But they are good examples of raising our kids with the idea of "kids first, diabetes second".
That "kids first, diabetes second" is a very important part of raising healthy minded (and bodied) children. What we risk by strictly counting calories, limiting choices or creating the idea that food is BAD, is instead, raising a child who might choose to sneak food, have poor self-esteem and make uneducated choices in their own diabetes care as adults.
What we don't want to do is create "adults depressed, diabetes distressed."
We, as parents, want to create a healthy environment that teaches children to listen to their bodies, take care of it through good nutrition and lots of exercise - all while enjoying an occasional treat AND counting carbohydrates AND dosing insulin.
Well, than if you understand these nuances of life and are now sitting there and wondering if your child's A1c is good enough? I am here to tell you that it is.
What you are striving for is to connect with your child, foster an environment of caring, nurturing, teaching to continually educate you and your loved one living with type 1 diabetes. Around here, we use the A1c as a guide to help remind us where we are headed and what we would like to try to do differently.
- Perhaps it is focusing on bolusing 15 minutes before eating dinner.
- Maybe it is to make sure our tween is entering her blood sugars (all of her blood sugars) back into the pump, so we have a better focus of what is happening.
- Or perhaps, we are even seeing an A1c that is suspiciously too low and maybe we want to try to wear a CGM for the first time to catch some hidden blood sugars.
Whatever it is you use to do with the information, the A1c is simply a moving target to help remind you to take action in your own diabetic care.
What the A1c is not:
- A Gold Star
- A Validation for Parent of the Year
- A Scarlett Letter
- Or anything to be used to judge a family or loved one whom is living with type 1 diabetes
I always find it sad to hear one parent bragging up an A1c or talking down another. It makes me wonder how their endocrinologist is teaching the family too. Do they get a positive praise for only so-called good A1c's and sharply reprimanded for bad ones?
I hope not.
An A1c is what it is and you can guarantee that it will change several times (probably too many to count) during the time we have until a CURE. Until then, if you see someone struggling or wondering if the have a good enough A1c, give them a hug and remind them of all the work and love that they put into their child's care. And yes, it is most definitely good enough!
Youngest daughter, age 9: 7.8 HbA1c
Oldest daighter, age 11: 8.2 HbA1c