Son's A1c was 7.2(question) [Archive]

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momof6

11-01-2006, 06:59 AM

Little backround;son is 4, was dx at 3. Anyway 3mo ago it was 7.2, which was surprising b/c he was having 1-2 high readings a day. When I brought his numbers up on another board, they said his next one would probably be high, but i never asked why..just felt like they were trying to steal my joy. Anyway does anyone know the reasoning behind that?

JediSkipdogg

11-01-2006, 07:06 AM

Not sure why they say the next one will be high. A1Cs can have drastic changes in 3 months. How often does you son have one done and how often does he test his blood? That could then help to get it lower. But personally, for a 4 year old, 7.2 is great.

momof6

11-01-2006, 07:14 AM

Funnygrl

11-01-2006, 07:38 AM

momof6

11-01-2006, 07:41 AM

You really need to try and get in touch with a pediatric endocrinologist. I know it's hard, but ideally he should be having a1cs every 3 months and be on more than 2-3 shots a day.

Thanks. He is getting his a1c done again this fri. The only reason he gets 2-3 shots is becuase his numbers are good at all the other readings. If I gave him more they would drop dangerously low.

Funnygrl

11-01-2006, 07:49 AM

Thanks. He is getting his a1c done again this fri. The only reason he gets 2-3 shots is becuase his numbers are good at all the other readings. If I gave him more they would drop dangerously low.
Ah, that's good. He's probably honeymooning. What type of insulin does he use?

momof6

11-01-2006, 08:02 AM

regular, novalog, and nph. he gets nph once a day(right before brk w/ reg) the novalog he gets at lunch(sliding scale, if it's 150 or over) the reg he gets if his sugars are high inbetween readings.

JediSkipdogg

11-01-2006, 08:07 AM

momof6

11-01-2006, 08:20 AM

He doesn't take any NPH at dinner? That could be one reason his A1C is high. NPH only lasts 10-12 hours, therefore, by the evening and while he is sleeping it's all out of the system and he has no insulin.

Also, how often does he check his sugar levels?

7.2 is high? I thought that was good. I check anywhere from 4-6 times a day. At dinner we only do a sliding scale, example if it's 200, I will give 2units of reg(sometimes 3 if I know he will eat it all and possibly have 2nds) He doesn't always finish his food which is a hassle. I am afraid that if I give nph it might go too low and he could go into a coma. Fortunately when he is napping or asleep and it has gotten too low,....he wakes up in a frenzy(crying and screaming)

momof6

11-01-2006, 08:22 AM

btw, thanks for all the info. I'm still learning, so anything that you think I should be doing let me know. Of course I have to run everything(changes) by the dr too.

JediSkipdogg

11-01-2006, 08:43 AM

momof6

11-01-2006, 08:47 AM

7.2 is good but high, lol. Around a 5.0 is what you consider normal. Anything above 8 is danger and above about a 10 would be take some corrective actions ASAP.

Have you woken him up in the middle of the night and tested his blood sugars? What are the numbers generally like then.

In the beginning I would test at night, but I guess it wouldn't be a bad idea to start again. I guess I could do it when one of my others wake up (the baby)

Hmm, thanks for that tidbit about the a1c numbers!

DeusXM

11-01-2006, 08:56 AM

Careful when it comes to A1C numbers and children. Opinion is somewhat divided about what is right for children. A lot of people in diabetes medicine prefer to suggest that children can reasonably safely get away with slightly higher A1Cs than adults.

I personally would consider an A1C of 7.2 for myself as 'reasonable', but with a lot of room for improvement. For a 4-year-old, I'd say it's pretty good. Try and keep in under 8, and once he's been through puberty (I know, that's a **** of a long way off!) look about getting it under 7.

SueM

11-01-2006, 09:03 AM

Your little lads A1c is great at 7.2 childrens levels are different to adults.

Gangrel

11-01-2006, 10:49 AM

My last A1C was 6.8, and my endo only wants me around 6.... not down to 5. Man, I think it would be impossible to be below 6 for a long time, just due to the normal curves and swings your BS goes through........

spike

11-01-2006, 11:17 AM

Jackets

11-01-2006, 02:13 PM

They keep on shrinking the recommended A1C levels. What do they think we are? Computers?

caryj

11-01-2006, 06:50 PM

7.2 is fine enough in my opinion. Children need enough freedom to be kids. What you really need to look out for is severe highs and lows that are not being tested. These will reflect in the A1C even if they aren't in your meter.

duck

11-01-2006, 07:12 PM

HI. Thanks for your reply. That was only his second a1c, the first one was when he was first dx, and I have no idea what it was(don't even have those records) We are a military family, and moved about 10months ago, and were just seing a reg ped. So in the 13mo he's had D, he's only had two a1c's. He gets anywhere from 2-3 shots a day.

I'm an Army brat, was diagnosed and hospitalized at Dewitt Army Medical Hospital, Fort Belvoir, VA in 1990...The worst advice I got regarding this disease was from that institution. I am not saying they did it on purpose, but knowing what I know now, I am still scratching my head trying to figure out if they realized it was 1990 and not 1940?

Anyway, your son's A1c is fine. As DeusXM and others stated, 7.2 for a child is "safe".

I also agree with others it's a bit weird that you are only administering NPH once a day. Personally, I would advise you get off that **** and onto Lantus if possible--Though I can't recall if it has been approved for children that young (I know they have studies that say it's safe).

And as long as I am rambling, go get the book "Pumping Insulin" by John Walsh (it's on Amazon); Yeah, it's a pumping book, but when I first read it, I kept repeating "I wish someone had told me that years ago", albeit I cussed a lot more since I was a little annoyed. :)

And lastly, how often do you test per day?

Funnygrl

11-01-2006, 07:58 PM

I'd say the a1c is great, but I would get off the N just for your own sanity.

lilituc

11-01-2006, 10:12 PM

And as long as I am rambling, go get the book "Pumping Insulin" by John Walsh (it's on Amazon); Yeah, it's a pumping book, but when I first read it, I kept repeating "I wish someone had told me that years ago", albeit I cussed a lot more since I was a little annoyed. :)

Not to sound like a broken record, but John Walsh wrote a book for MDI, too. It's called "Using Insulin."

duck

11-02-2006, 12:34 AM

Not to sound like a broken record, but John Walsh wrote a book for MDI, too. It's called "Using Insulin."

O RLY?

Yup, I just "amazoned" it, and here ya go:
Amazon.com: Using Insulin, Everything You Need for Success With Insulin: Books: John Walsh,Ruth Roberts,Timothy Bailey,Chandra B. Varma (http://www.amazon.com/Using-Insulin-Everything-Need-Success/dp/1884804853/sr=8-1/qid=1162456376/ref=pd_bbs_sr_1/102-1612789-7252124?ie=UTF8&s=books)

I've never read it (obviously), but considering the source, I'd recommend it.

momof6

11-02-2006, 03:41 AM

I'm an Army brat, was diagnosed and hospitalized at Dewitt Army Medical Hospital, Fort Belvoir, VA in 1990...The worst advice I got regarding this disease was from that institution. I am not saying they did it on purpose, but knowing what I know now, I am still scratching my head trying to figure out if they realized it was 1990 and not 1940?

Anyway, your son's A1c is fine. As DeusXM and others stated, 7.2 for a child is "safe".

I also agree with others it's a bit weird that you are only administering NPH once a day. Personally, I would advise you get off that **** and onto Lantus if possible--Though I can't recall if it has been approved for children that young (I know they have studies that say it's safe).

And as long as I am rambling, go get the book "Pumping Insulin" by John Walsh (it's on Amazon); Yeah, it's a pumping book, but when I first read it, I kept repeating "I wish someone had told me that years ago", albeit I cussed a lot more since I was a little annoyed. :)

And lastly, how often do you test per day?

HOOAH:tee:

I grew up an AF brat. They have it a bit better:)

About the NPH, I've heard elswhere I should ditch it and take up lantus. This is another thing I will ask my dr about. I figured since his numbers weren't that bad and he seemed to be taking to the meds accordingly, why change it..but I've heard alot of good things bout lantus.

I take his bg 4-6 times a day.

Funnygrl

11-02-2006, 03:54 AM

I'd say chances are you may have some kind of honeymoon period going on, and starting the Lantus now and ditching the N now will make things easier in the future.

momof6

11-02-2006, 04:31 AM

You guys rock! I'm so glad I found this site. Now I need some ammo, b/c as you know, not all dr.s listen to the wishes of their patients(or the patients parents) If the dr. asks why do I Want to switch, I'd like to give an educated response. So in a nutshell what are the benefits.

I also like to appear smart in front of them using medical terminology..it usually shocks em:rofl: Having 6kids I sometimes think I know more than some of these family practice dr.s. Sad really..

DeusXM

11-02-2006, 04:37 AM

If the dr. asks why do I Want to switch, I'd like to give an educated response. So in a nutshell what are the benefits.

The primary difference between Lantus and NPH is that Lantus has a flat action profile. This means that you have a consistent level of insulin activity at all times. NPH has a peak, which means it starts working really hard around the 4-hour mark and runs out of steam around the 12-hour mark. This means you're quite prone to hypos at one time and quite prone to hypers at another.

With Lantus you don't get this problem, so you get more flexibility when you can eat. Also, Lantus lasts for 24 hours so you only need one injection of it a day to get good control.

Stuboy

11-02-2006, 04:41 AM

yeh, im amazed at how flexible i can be now with eating times. I switched to Lantus and Novorapid from being on Mixtard. I still have the odd hypo here and there but no way near as much as before. Hypo's are down to mis counting carbs and taking too much novorapid.

momof6

11-02-2006, 04:42 AM

The primary difference between Lantus and NPH is that Lantus has a flat action profile. This means that you have a consistent level of insulin activity at all times. NPH has a peak, which means it starts working really hard around the 4-hour mark and runs out of steam around the 12-hour mark. This means you're quite prone to hypos at one time and quite prone to hypers at another.

With Lantus you don't get this problem, so you get more flexibility when you can eat. Also, Lantus lasts for 24 hours so you only need one injection of it a day to get good control.

Would I still mix it with the regulara tho. Ie, he gets 4regunits along with 3units of nph right before breakfast.

I would hope this would eliminate his dip. He gets a hypo by 10am(50 or less) and needs a snack to pick him back up.

duck

11-02-2006, 08:46 AM

Would I still mix it with the regulara tho. Ie, he gets 4regunits along with 3units of nph right before breakfast.

I would hope this would eliminate his dip. He gets a hypo by 10am(50 or less) and needs a snack to pick him back up.

Lantus cannot be mixed, so in effect, you would be giving your son an extra shot per day (keep in mind some people experience greater control with two lantus shots per day).

NPH is dangerous and volatile, as far as I am concerned. No one ever explained this to me, but NPH can work as intended some days, take a nice vacation (not work well at all) on others, and then somehow show up with all the rage and fury of insulin on others. With that kind of inconsistency, the problem(s) develop if via testing you decide you are taking the correct dose of NPH...and the NPH is working harder than normal. What happens when it starts to work normally or less than normal? Control gets whacked, you make adjustments...that's all good until it changes again.

I know none of what I just posted is scientific (I'll leave that for JasonSmithMT, mark-TN or Deus to delve into if they so choose), but that's been my experience with NPH and others here as well. But I would be remiss if I didn't say there are those who seem to do well on NPH and those that seem to do poorly on Lantus.

duck

11-02-2006, 08:47 AM

Oh, and AF brat. :eviltongu You guys DID have it better, and I'm jealous! LOL

DeusXM

11-02-2006, 08:53 AM

Would I still mix it with the regulara tho. Ie, he gets 4regunits along with 3units of nph right before breakfast.

Yes, you'd still mix with a bolus insulin. What would happen is you would give him one injection of Lantus a day, and then an injection of regular before each meal.

duck

11-02-2006, 09:10 AM

Yes, you'd still mix with a bolus insulin. What would happen is you would give him one injection of Lantus a day, and then an injection of regular before each meal.

Wait, I thought you are not supposed to draw both Lantus and any other insulin together in the same syringe? Or am I misunderstanding the process or the question???

spike

11-02-2006, 09:13 AM

Wait, I thought you are not supposed to draw both Lantus and any other insulin together in the same syringe? Or am I misunderstanding the process or the question???

From Lantus.com

DO NOT DILUTE OR MIX LANTUS® WITH ANY OTHER INSULIN OR SOLUTION. It will not work as intended, and you may lose blood sugar control, which could be serious. Do not change your insulin without talking with your healthcare provider. The syringe must not contain any other medication or residue. You should not use Lantus® if you are allergic to insulin. Lantus® is a long-acting insulin you inject just once a day, at the same time each day.

Scratch

11-02-2006, 09:17 AM

When DeusXM said mixed, he didn't mean mixed in the syringe, I think.

duck

11-02-2006, 09:52 AM

From Lantus.com

DO NOT DILUTE OR MIX LANTUS® WITH ANY OTHER INSULIN OR SOLUTION. It will not work as intended, and you may lose blood sugar control, which could be serious. Do not change your insulin without talking with your healthcare provider. The syringe must not contain any other medication or residue. You should not use Lantus® if you are allergic to insulin. Lantus® is a long-acting insulin you inject just once a day, at the same time each day.

When DeusXM said mixed, he didn't mean mixed in the syringe, I think.

Cool, thanks to both; I was pretty sure I had read over and over not to mix Lantus with ANYTHING.

Scratch

11-02-2006, 10:04 AM

Cool, thanks to both; I was pretty sure I had read over and over not to mix Lantus with ANYTHING.
Yeah, they're pretty adamant not to mix Lantus with any other insulins in the syringes or re-use any syringes which could result in any sort of Lantus/other insulin interaction, although none of us have ever re-used a syringe, right, right? Heck, I'll even not inject in the thigh where I last injected my Lantus shot just to be on the safe side.

melissata

11-02-2006, 12:00 PM

regular, novalog, and nph. he gets nph once a day(right before brk w/ reg) the novalog he gets at lunch(sliding scale, if it's 150 or over) the reg he gets if his sugars are high inbetween readings.

It doesn't make sense to me that they have you using regular insulin instead of Novalog to bring down highs. Novalog works much faster and is out of the body sooner.When my kids were first diagnosed, they used regular to cover breakfast and lunch, and Humalog for highs. There are good and bad things about Lantus that you should know about that no one mentioned. One is that everyone doesn't get 24 hour coverage from it, and has to take it twice a day. The other thing that is important is that you need a shot of Novalog EVERY time he eats any carbs. If he is used to eating snacks, and wants to continue, it will mean a lot more than 2 or 3 shots a day. My daughter got good coverage from Lantus, but I hated having to give her so many shots. She likes to eat a snack in the afternoon after school and bedtime. That was 6 shots a day. We decided a pump would be a better way to go for her. Lantus is not approved for kids under 6, but lots of doctors prescribe it off label. Peaking basal insulins are hard to manage, because you have to eat or risk a low. You can postpone meals and even skip meals on Lantus, but the trade off is more shots. You have to decide what would work better for your family. There is also another basal insulin that is called Levemir. My son is on it, and it works better for him than Lantus ever did. Some people need 2 shots per day of that also, but he only needs one. I don't know of any little ones on it, because it is newer. I give you a lot of credit handling this with 6 kids! Mary

momof6

11-02-2006, 12:30 PM

It doesn't make sense to me that they have you using regular insulin instead of Novalog to bring down highs. Novalog works much faster and is out of the body sooner.When my kids were first diagnosed, they used regular to cover breakfast and lunch, and Humalog for highs. There are good and bad things about Lantus that you should know about that no one mentioned. One is that everyone doesn't get 24 hour coverage from it, and has to take it twice a day. The other thing that is important is that you need a shot of Novalog EVERY time he eats any carbs. If he is used to eating snacks, and wants to continue, it will mean a lot more than 2 or 3 shots a day. My daughter got good coverage from Lantus, but I hated having to give her so many shots. She likes to eat a snack in the afternoon after school and bedtime. That was 6 shots a day. We decided a pump would be a better way to go for her. Lantus is not approved for kids under 6, but lots of doctors prescribe it off label. Peaking basal insulins are hard to manage, because you have to eat or risk a low. You can postpone meals and even skip meals on Lantus, but the trade off is more shots. You have to decide what would work better for your family. There is also another basal insulin that is called Levemir. My son is on it, and it works better for him than Lantus ever did. Some people need 2 shots per day of that also, but he only needs one. I don't know of any little ones on it, because it is newer. I give you a lot of credit handling this with 6 kids! Mary

Wow, you have two kids with D? I did forget about that little tidbit that they usually don't prescribe lantus for those under 6. He will be 5 next month. Sometimes I'll give novalog right before a snack, it just depends. My husband gets anal with me, bc I don't follow the chart(they gave us when he was first dx, the amt of insulin etc) to a 'T', but he doesn't realize that it's ok to tweak it accordingly. He still to this day when giving him shots, has to refer to the list..while I go by tria,l error, and most of all, instinct. I'd really like to hear more from you, ie how long your kids have had it, and your experience with diff insulins. Thanks

Oh btw, I have 3 in school and 3 at home, and a hubby who's not deployed (YET) so it's all good:)

lilituc

11-02-2006, 09:00 PM

Duck, Using Insulin has a graph of NPH action variability over three days. It's pretty eye-opening. So I think the inconsistency of action from day to day is a good argument to give an endo.

momof6

11-03-2006, 06:10 AM

Correction; his last a1c was 6.7. I was going over his records this morn. He gets tested today, fingers crossed......

mary1812mary

11-03-2006, 06:42 PM

It seems the best results are with Lantus (long-acting basal) and Novolog with meals (bolus). It's a great starting point. NPH and Regular are really "old school" now, because most on this regimen have difficulty controlling bgs. The most recent and successful regimens are using Lantus (long-acting) and Novolog or Humalog for boluses. It closely mimicks the insulin pump (though nothing is AS GOOD AS A PUMP for T1's).

Please talk to your endo about changing the regimen--get rid of the NPH (a most difficult insulin for managing bgs) and regular (which takes too long to act for meals). You will definitely find more success with Lantus and Novolog. I've used it, and MANY others have also, to much success, but even find more success with the insulin pump (Minimed 522 for me) using Novolog. My A1Cs are in the 4.9 to 5.2 range.

Be your own advocate--become educated, and insist on what you know is the best for you or your loved one!

Mary