From Virginia, USA:
My daughter, age 15, has recently gotten her Hemoglobin A1c results back and it was the worst ever: 13.1! Her readings are generally in range, 80-180. How can this Hemoglobin A1c be so high? I am very distressed about this and trying to find a pediatric endocrinologist that she will go to -- we've tried one nearby, and she refuses to go back -- what to do now?
Assuming that her meter is working correctly, her technique is correct, and there was no lab mix-up, the only explanation is that she is not telling you the truth about the blood sugars.
At this age, insulin and food requirements can go up rapidly. Many teenagers don't want their parents or doctor to know that their blood sugars are out of control. This is, of course, the age when teenagers have hectic schedules and peer pressure that often make it harder to find the will power to follow the diabetic meal plan and insulin regimen. Often the teenagers refuse to go to the doctor because they don't want the parent to know that they are out of control, especially if the doctor suspects this.
It is important for you and/or her doctor to sit down with her and be completely honest that the HbA1c does not match with the blood sugars. If she has a meter with a memory, you may be able to review the recent blood sugars and see that in fact they do not correspond with what she reports. If she doesn't have a meter with a memory, it is important to get one. Some teenagers are very sophisticated at getting the meter to actually read lower than it should by either changing their technique or the meter code. I usually recommend that in a case like this that the nurse or doctor observe the teen's technique in checking the blood sugar and send a simultaneous blood sugar to the lab to confirm the accuracy of the technique, strips, and meter (I do not rely on control solutions). I also usually suggest that the teenager obtain 2 different brands of meters with memories. Initially a parent and the school nurse if she tests at school should observe the child testing the blood sugar with both meters at the same time. It is unlikely that even a sophisticated teenager can manipulate 2 different meters to get identical false blood sugars. A parent should also observe the child giving the insulin.
Often there is some other stress in the teen's life such as poor school performance or peer pressure that is causing the teen to "ask for help" by not taking care of her diabetes or forcing the parent and physician to deal with discrepant blood sugars and HgbA1c readings. It would also be very important at this time to try and get your child or even the family into therapy to cope with the dual stresses of adolescence and diabetes. If you ignore the warning signs now, your daughter may go to the next step of letting her diabetes get so out of control that she develops life-threatening ketoacidosis (especially if she skips insulin or is not raising her insulin as needed).
Additional comments from Dr. John Schulga:It is possible that the test results are correct, and she is telling the truth, but the tests are being performed at the times when blood glucose readings are likely to be not too bad. We should be careful about how we approach this problem, and try to keep the teenagers on the side of the parents and not try to alienate them from any support they need.
Last Updated: Tuesday April 06, 2010 15:09:09
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