Tuesday, February 1, 2011

The quarterly report card

Tomorrow is Sarah's appointment in the Children's Specialties clinic at Kaiser. She'll see a nurse, doctor (Endocrinologist), nutritionist, child-life specialist, and a social worker. The whole appointment takes about three hours. They talk to us about diabetes management, read through her bloodsugar readings for the last three months - and give us the much anticipated A1C result.

The A1C is our report card. The A1C measures the amount of glucose that has built up in her red blood cells over about 90 days, so it gives us a fairly accurate view of her average bloodsugar.

A "normal" A1C is between 4.0-6.0 (though the Mayo clinic considers an A1C of 5.7 or higher pre-diabetes). Most diabetics aim for an A1C under 7.0, but this is not always easy to achieve. Sarah's last A1C was 6.5 - which is pretty good. But at the time she was having quite a few lows, so our goal this time was to keep the A1C under 7.0, while significantly reducing the number of lows she has.

Pre-game statistics

In the week prior to her last appointment (November 2):
4 - bg readings below 70
114 - Average bg
37 - Average carbohydrates in a meal

This past week:
0 - bg readings below 70 (her lowest was 77)
142 - Average bg
35 - Average carbohydrates in a meal

As you can see, Sarah hasn't had any serious low bloodsugars in the last week - this is a very good thing because low bloodsugar is dangerous. Her average is a little higher than I'd like to see, as her goal is 120. However, this number is somewhat inflated because it only takes into account the tests we perform, and I often have Sarah test an hour or so after a treat just to see where she's at and if she's going to need a correction. If I only tested at mealtimes, this would be lower.

Why do we care so much about her A1C? A good A1C significantly reduces the risk of future medical complications. "the Diabetes Control and Complications Trial (DCCT), ... found that for every one percentage point a patient reduces their A1C they lower their risk of microvascular complications 37%. The study also found that keeping blood sugar levels as close to normal as possible slowed the progression of diabetes-related eye, kidney, and nerve diseases."

So it's not just about keeping bloodsugar from becoming dangerously high or dangerously low. We strive to keep her bloodsugar as close to "normal" as possible. In a Type 1 diabetic, bloodsugar can swing wildly. A small snack, such as an apple juice or handful of crackers, can drive her bloodsugar up well over 100 points. Once I gave Sarah a bag of fishy crackers when her bloodsugar was around 70 - and an hour later she was near 250! Can you imagine? And she feels every swing in bloodsugar. She might feel shaky and sweaty at 60, and develop a bad headache over 250. So we walk a fine line, balancing carbohydrates and protein carefully to try to keep her bloodsugar as level as possible.

And every three months we walk into the Endocrinologists office and await our report card.

Edited on 2/2/2011 - The result? 6.5