Tuesday, April 26, 2016

Teen A1c : You got Some Splainin To Do!

Reducing the A1c 'Suck Factor' is hard to do. 
Heading into our endocrinology appointment last Friday, I could feel my anxiety building.  I was grumpy while downloading pumps, sleepless the night prior in thinking about the many steps needed for getting the girls on a school day and even more tired (cranky) than usual during the morning of due to my restless energy the day before.

It's a vicious mental cycle.  Worry, rinse, repeat.

While it's not often that I feel such a rush of emotions over such a ridiculous test like the A1c (one sun-in-your-eyes snapshot of what we have been through over three months), but for this appointment I had wandered off onto my own parenting path for several endocrinology-related decisions.  While I stood firm in feeling that I had done what was best for our little family, I also felt a tremendous amount of pressure in having to explain what had happened.

Sometimes, it feels necessary to assess the T1D situation and decide the best course of action as it relates to your child.  So I took off onto a parenting road that led to three small changes:

First, the Naturally Sweet dad and I assumed control over our youngest's T1D during all 'at-home' times.  Yes, some young teens can handle all of the day-to-day tasks but some children, like ours, need a break.  This is perfectly normal and honestly, to be expected.  Managing T1D is a huge responsibility and one that easily can lead to burn-out.  Our youngest felt overwhelmed in trying to remember to do it all, so as parents, we assumed responsibility for early a.m. pre-bolus, site changes and evening bg checks.  We never gave up the middle-of-the-night blood sugar tests, so we continued to manage that as well.  During the school day, we simply asked her to test before lunch and add up her carbs from her bagged lunch.  To help with a reminder for school, we added a simple lunch time alarm to her iPhone.  We also gave her the option of having mom drop by school but she declined that on the premise that it was 'embarrassing'.  To counter that thought, we agreed that mom would not appear as long as our youngest managed the bg test and bolus responsibilities.  Youngest feeling victorious and relieved, eagerly agreed and to date, hasn't missed a lunch bolus in over 7 weeks.  The result?  A happier, healthier, mentally-balanced kid with a major reduction in A1c from 8.3 to 7.7.  

Secondly, our oldest daughter is spending so much time of her day away from home in activities that even though she is compliant in managing her care, we felt that she could alleviate a few of her extra bg checks.  Our concern wasn't instilling habits to take care of her T1D, rather it was to reduce the anxiety that comes from overly checking bg.  Since both of our girls wear continuous glucose monitors (CGMs) 24/7, we opted to use the data on the CGM to eliminate finger stick blood sugar tests before exams and before transitioning to activities.  We maintained the need to always check before driving a car and before any PE related activity; especially swim-related events.  The result?  A happier, healthier, well-balanced kid with a maintained A1c from 7.1 to 7.4.  

Finally, at our last endocrinology appointment, we were presented with the idea of having a do-over A1c for our youngest as she dealt with having her first A1c in the 8's.  At first glance, it seemed like a terrific option, especially for the kid that strives to be a high achiever in all that she does.  The endocrinologist knew that our youngest was due for another TSH check and felt that it might be great to tie both tests to one blood draw at the 6 week post-appointment time.  However, as time chugged along, it became clear that having that 6 week post-appointment A1c on the calender caused more stress, worry and anxiety than a regular appointment would have.  So I dug deep, evaluated the situation and decided to erase the calendar.  Perhaps for many children and teens, this would be a wonderful re-do but for our particular child, one that is sensitive, bright and goal-driven, this created a hyper-focus on achieving a target that in all reality is sometimes unattainable due to illness, hormones, puberty and growth.  I couldn't set her up to think that she had 100% control over delivering 'perfect' when it truly may have been somewhat out of her reach at that particular time.  The result?  Happier, healthier, well-balanced kids and parents without a worry as toward what the next A1c would be.  

As our Friday appointment concluded, it felt good to know that the decision making was well-received by our entire endocrinology team.  Talking out the explanations helped to spur thoughtful conversation regarding the individual needs for our daughters at this age and stage.  While approval wasn't exactly necessary, it was a nice gesture.  As a cohesive team, changing the T1D strategy mid-way without needing approval underscores our goal of creating a partnership for both of our daughter's care.  Sometimes, the best ideas will come from endocrinology, sometimes from parenting and sometimes from the girls themselves.  At the end of the day, it doesn't really matter... it only matters to know that we can work together to achieve the very best results; happier, healthier, well-balanced kids and parents.

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