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Question:

From Waukegan, Illinois, USA:

To make a long story short, 95% of my daughter's blood glucose levels are within the normal ranges of 80 to 130 mg/dl [4.4 to 7.2 mmol/L]. However, we have been unable to get her A1c level below 10 for the past five years. We have been accused of submitting bogus numbers and manipulating the machine, which is not the case. I have taken her blood glucose levels myself upon occasion and watched her take her insulin. That is not what is happening here. I asked her primary pediatrician to get a second opinion, which he doesn't feel is necessary, so I just switched pediatricians.

Her pediatric endocrinologist is really at a loss as to what is going on. During last Thursday's appointment, she flat out said she did not know and asked me if I had any suggestions. We seriously need some help here.

She does not get good absorption in her stomach. When she takes her shots there, her A1c goes up to 12. She gets better absorption in her extremities.

Answer:

Common things happen commonly. I think that the experience of many diabetologists is that the most common reason for poor glucose control is poor attention to meal planning, insulin administration, and/or routine activity/exercise.

Given that you have started this investigation, I presume that you have confirmed that the glucose meter(s) have been checked for accuracy and that the meter code strips (if you have that type of meter) have been matched with the meter.

You indicated that you have checked her glucose levels yourself on "occasion" and have "watched her take her insulin." I would gently ask you not to peripherally oversee her care in this way: five years of A1c values, if correct, are certainly in higher risk for the development of diabetes complications. I urge you to GIVE the insulin YOURSELF and to check the glucose values YOURSELF for three to four weeks and see how things evolve.

Rarely, irregularities in the blood, such as a variant of normal hemoglobin, will give a falsely high (or low) A1c, depending on how the A1c is measured.

Also, the use of a Continuous Glucose Monitoring System (CGMS) for three or more days may be extremely helpful to you and your daughter to try to "unmuddy" the waters.

Good luck and let us know what you learn.

DS

DTQ-20060622151828
Original posting 26 Jun 2006
Posted to A1c, Glycohemoglobin, HgbA1c and Daily Care

  
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Last Updated: Tuesday April 06, 2010 15:10:08
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