conflicting advice

[shellyk]

Hi all, some advice needed please. My daughter has been type 1 for a nearly a year now, we havew had many ups and downs but seesm to be getting to grips with things. we now carb count and work out bolus of nova rapid with the accu chek expert and things are ok she has moments of madness, like shooting up 17 post breakfast this morning after starting at 4.5 !! but generally her post meals are under 10, On her last clinic visit her hba1c was 7.2 % and her consultant seemed pleased with her and will see her in 4 months, follwowing this we saw her DSN and the dieticain together, we gave us very conflicting advice that seemed to think that was to high and her control needs to be better, I should have mentioned earlier she is 15 so we do battle with puberty and she is aslo in the middle of her first lot of GCSE so loads of stress, at the same time that are very relectant to teach me how to correct highs as that are worred she will hypo !! Ther attitude was so negative that my daughter is now refusing to see them at all.

So i guess my question is , what is a ok hba1c for a teenager i reaaly don.t want to put her health at risk but it feels like we stuck in the middle

Thanks in advance

 

[hanadr]

Growing youngsters are difficult, but I would remember they have a LOT of years to live with this and that non-diabetics have an HbA1c of about 5% or even below that. I suspect the figures given by Diabetes Uk for acceptable numbers are affected by what the medics think most people can achieve with not too much trouble. GOOD control requires dedication, which isn't common in teens.
A thorough discussion with your daughter on what she tthinks she can manage will help. Also, I wouldn't rely on insulin to do all the work. I'd go for a controlled carb diet and exercise too.
Having worked with teenagers all my working life, I'd also see how much responsibility for control she can handle [with your back-up of course].
The nearer your daughter can get to normal blood sugars without risking loads of hypos, would be what I'd aim for in your circumstances[ which I admit I haven't experienced, but I did have a teenager once. Now it's grandchildren)]
Dr. Bernstein's Diabetes Solution has quite a bit about children and in that includes teenagers. I always refer to his book when Ihave a question.

 

[AMBrennan]

For the record, Dr Bernstein's "truly excellent" book conflicts with official NHS advice; discussing the merits of the book, however, would probably take an entire thread of its own.

I would go with the consultant's advice as it is in line with NICE guidance (for adults HbA1c < 7.5 or <6.5 if heart risk). Did you ask the consultant or the nurse why assessment differed from the other's?

I'd go for a controlled carb diet and exercise too

Whilst exercise is obviously good in general I am not aware of any evidence that suggests that exercise improves blood glucose control in type 1 diabetics, where obesity and insulin resistance is much rarer.

 

[iHs]

Hi all, some advice needed please. My daughter has been type 1 for a nearly a year now, we havew had many ups and downs but seesm to be getting to grips with things. we now carb count and work out bolus of nova rapid with the accu chek expert and things are ok she has moments of madness, like shooting up 17 post breakfast this morning after starting at 4.5 !! but generally her post meals are under 10, On her last clinic visit her hba1c was 7.2 % and her consultant seemed pleased with her and will see her in 4 months, follwowing this we saw her DSN and the dieticain together, we gave us very conflicting advice that seemed to think that was to high and her control needs to be better, I should have mentioned earlier she is 15 so we do battle with puberty and she is aslo in the middle of her first lot of GCSE so loads of stress, at the same time that are very relectant to teach me how to correct highs as that are worred she will hypo !! Ther attitude was so negative that my daughter is now refusing to see them at all.

So i guess my question is , what is a ok hba1c for a teenager i reaaly don.t want to put her health at risk but it feels like we stuck in the middle

Thanks in advance

Hi

Have you looked at the BDEC website regarding carb counting and using ratios? It will only be by your daughter testing her bg levels 6 times a day that you will be able to work out what ratio she needs to use for the time of day that she tests. For correction doses of insulin to also work ok, you will need to find a day when the amount of insulin injected starts to produce bg levels that are at fairly good level (this can also include any insulin that is used as a correction). Once youve got a decent TDD during the day, you can then divide that into 100 to work out roughley how much 1u of bolus will make bg level drop.

The way to work out a correct ratio is to aim for a sensible bg level before she eats a main meal and a sensible bg 2.5hrs later. You keep adjusting the ratio until you are able to reach that.