# HbA1c



## Carynb (Jul 21, 2010)

Am interested in what is considered a "good" HbA1c in children.
Last week J was 7.7% which is the same as last time.DSN said it was very good but Consultant said we could get tighter control so not sure what to believe!!
We are seriously considering applying for a pump too- will post separate thread for that!


----------



## Copepod (Jul 21, 2010)

Is it possible they're both right? I know my HbA1c is OK, but could be better - it's a trade of between risks and benefits, which I know is different to me making my own decisions for myself as an adult, rather than making decisions for a child, but perhaps still valid? I'm sure you want more certain answers that that, but perhaps there aren't any?


----------



## Northerner (Jul 21, 2010)

I think what Copepod says may be true - it depends a lot on how the HbA1c compares with day-to-day readings. If there are quite a few highs pulling the average up then it may be possible to determine the cause of (at least some of) them, thus getting tighter control and bringing the Hba1c down - rather than attempting to get the lower readings lower and risking more hypos. So, you would be aiming to reduce at the upper end of his range, but not at the lower end.

Hope that makes sense! From reports I have read here, a pump usually improves the numbers, although not in the early days when you are getting used to it.


----------



## Carynb (Jul 21, 2010)

Makes perfect sense as he does have a few higher reading later in the day towards bedtime otherwise he goes hypo at night. So yes I suppose they are both right.
Thanks for explaining!


----------



## Jacqui (Jul 22, 2010)

The HbA1c we aim for in this country for children is to be below 7.5% though this is actually lower in other countries at 6.5%. It is a simple graph when you look at complications compared to HbA1c, the higher it goes the more at risk you are of long term damage. The lower it goes the more at risk you are of severe hypos. 
It is a matter of balance really. I aim for the 6's but I have only been able to get my kids HbA1cs in the 6's since using a pump and continuous glucose monitoring. Before that they would only be in the 7's with hypos thrown in too often to be happy. To be in the 6's then they would have had to have lots of hypos which wasn't acceptable.
Since using sensors I have found the key thing is to avoid prolonged periods of higher levels, meaning any levels over 10 for longer than a couple of hours. At the moment it sounds like you are not sure where the problem areas are, so you could ask your supportive team to let you try a CGMS (continuous glucose monitoring) for a week so you can see where the problems lie. This would help immensly before going onto the pump, if that is the way you wish to go. However, your HbA1c is bordering on the good range so it may be you are happy with this for the time being and the age/activity level of your son. 
At the moment very few childen have the recommended HbA1c; under 30% get HbA1cs under 7.5 but what is even worse is how many spend years and years with HbA1cs over 8/9/10 etc. Discussing this nationally has clinicians scratching their heads. Mainly it is felt we lag behind Europe because we fail to express the seriousness of diabetes at diagnosis to families and patients, the expectations of teams are not high enough for the control which can be achieved, children being kept on mixed insulin when they need MDI or insulin pumps, a lack of on-going education for patients, families and clinicians and perhaps most shocking, that clinicians being put in charge of paediatric diabetes have no diabetes knowledge and DSNs do not have to have any diabetes training at all, only a level 6 nursing qualification so the uniformity of the teams expertise across the country is not good. 
There are things happening to address all these issues but they cannot happen fast enough for some areas. It sounds like you have a clinic where you can ask for more input which is just great. Many areas do not have even that basic support sadly. 
Paediatric diabetes only gets 1% of the entire funding pot for Diabetes in this country. This will be changing but plans have been somewhat held up by the change of government. Hopefully this will improve - let's face it, it has to!!


----------



## Monica (Jul 23, 2010)

"under 30% get an HbA1C under 7.5"

We've been told only about 16% get under 7.2.


----------

