A1c— It's Not as Easy as ABC
The A1c— or your child's three-month average blood sugar—quickly becomes a number you live by. It has many nicknames, such as hemoglobin A1c, HbA1c, glycohemoglobin, glycolated hemoglobin, and glycosylated hemoglobin. Parents need to understand not only what the A1c means, but also how to use that information to help their child.
What Is the A1c?
The A1c is a big picture of how in or out of range your child's blood glucose levels are over an extended period. A1c numbers differ from blood glucose numbers. Lab normal (in most labs) for a person without diabetes is 4.1–6.1 percent. To get an idea of what A1cs translate to, an A1c of 6 percent equals average blood glucose of about 135. You can add 30 to that number for every 1 percent increase in A1c, giving you an idea of what your child's true average is. Because meter checks only represent a brief moment in time, the A1c average may differ from what you are seeing on your meter.
Expect your child to have an A1c drawn at least four times a year. Ask your medical team if this will be the case for your child, and if it is not, ask that it be so from this time on. Be assertive for your child and proactive in her goal of a healthy lifestyle.
For very young children, medical teams often set a higher goal range for A1c levels, since the risk of lows can be greater with a small child who cannot recognize symptoms. For older children and adults, the tighter you keep your diabetes in control, the less chance of complications later in life. So target ranges are often aggressive. The American Diabetes Association recommends that every person with Type 1 should try to keep his or her level below 7. This is not easy to do, and your medical team won't want you and your child to beat yourselves up over it. Talk to them about the range they'd like to see your child in, and ways you can work to get there.
How to Make the A1c Work for You
It's easy to fall into a trap with A1cs. For many parents, they're almost like the SATs. While parents should be careful never to call their children's blood glucose readings “tests,” some look toward the A1c as if it were a midterm exam. They feel as if they're being graded. It's hard not to feel this way. But passing that feeling on to your child can have consequences. Find a way to simply use the A1c as information, not as judgment.
Spikes in A1c Levels
A sudden spike in an A1c level is a reason for concern. Your child may have completely outgrown her dosages and need a new plan. Or, your child could be withholding insulin without your knowing it. Even if your child is still in the 7s but has gone up a full percentage point, it's time to sit down and study the situation to determine what is changing, so adjustments can be made. This is exactly what the A1c is for: helping and guiding, not judging. Remember, if some boastful parent roughs you up by bragging about her child's 5.2 A1c, keep in mind that parents lie about A1cs just as they do about SATs. Take it with a grain of salt. Also keep in mind that some doctors advise against too low an A1c level in children because it can make feeling blood sugar lows more difficult. Come up with a personal plan for your child and forget everyone else.