New recommendations for Hemoglobin A1c targets from the American Diabetes Association (ADA) are out, and yes – they’re lower.
With 3/4′s of pediatric patients already missing the apparently inflated goal (8.0), dropping the standard to 7.5 may not produce the positive results the ADA’s looking for. Good or bad, it’s nice to see changes in protocols that have been in place for some time.
Changes in Hemoglobin A1c Goals
Asserting the previous guidelines as “outdated”according to Medscape, Dr. Laffel of the Joslin Diabetes Center noted that “modern technology such as insulin analogs, insulin pumps, and continuous glucose monitoring now allow for tighter control with less risk for hypoglycemia.”
True, but still scary – and technology can and does fail making for epic possibilities.
Our personal pediatric experience dates back to 2007 with my daughter and to 1984 for myself. We’ve always been taught “under 8.0″ which is about 180; our family’s goal is closer to 7.0. New recommendations suggest a hemoglobin A1c of 7.5 or roughly 150. That’s approximately a thirty point difference – and a reasonable goal.
Lets keep it real; we’re defying the laws of puberty and growth hormone fluctuations and our only sword is a a bottle of insulin.
Guideline Specifics
- Hemoglobin A1c under 7.5 for everyone under age 19.
- Hemoglobin A1c for adults is under 7.0.
I agree with tighter goals on many levels, but also question their practicality. Diagnosed at age 13 myself and parenting a child who was diagnosed at age five – and has been through her fare of growth spurts up to age twelve thus far – I know management in a child is a different ball of wax than in adults, hands down.
We certainly don’t want to see this:
But I’m here to tell you that “this” happens once in a while because diabetes isn’t perfect.
In fact, it’s not just us – technology isn’t perfect either and life happens. This screen doesn’t show the back story of great blood sugars before this happened or the fact that regardless of pouring insulin in, blood sugars remain high when a site goes defunct. It doesn’t tell you that I was up all night making sure she didn’t go low after the incessant corrections or that days like this turn me into a complete killjoy.
This is the face of diabetes.
I mean really – who doesn’t want better control – but what’s the price we’re willing to pay? The inadequacies of our tools are fully recognized; that’s why we have constant research underway.
We certainly don’t want this either:
However, just as high blood sugar happens – so do the lows and this is what can keep us fraught full of worry. If blood sugar results don’t give you pause at times, good for you – ignorance is bliss perhaps. Kids have more to lose with hypoglycemia; starving the brain of sugar on a regular basis is a quick way to impact the future of a child living with diabetes.
I like Dr. Laffel’s take on the recommendations; she doesn’t interpret them as a ‘cookie cutter’ style of doctoring. Dr Laffel in Medpage Today goes on to say: “”Lower blood glucose levels and lower A1c targets should be pursued as long as patients can avoid severe, recurrent hypoglycemia.”
One of the best pieces of advice to come from the ADA revolves around glucose testing needs. The ADA stepped out and recommended that people with Type 1 diabetes should be testing 6-10 times a day. They recognize the difficulties we face with insurance companies failing to approve the necessary amounts and blame that partially on recommendations that were blended with both Type 1 and Type 2 diabetes.
This position statement will give stronger footing to those of us struggling for approval with insurance companies. We just went through this in my family and went from 3 approved strips/ day to 10. You can gain headway with a voice.
To learn more about the Hemoglobin A1c test, see more from She Sugar: Hemoglobin A1c Test to Measure Blood Sugar.
Formulating an average three month blood sugar isn’t rocket science. Simply put, the life of a red blood cell is three months long, enabling testing for the average amount of sugar that adheres to the cell walls before they die. This number only provides an average and blood glucose values must always be taken into account. Averaging a bunch of highs and lows will also give a spectacular HgbA1c value – but it’s not the management we’re looking for.