NEW A1c guidelines from the American Diabetes Association

The American Diabetes Association just announced their new position on A1c targets, for children under the age of 19, who live with type I diabetes. What follows are snippets from the ADA story.

The Association now recommends that children under the age of 19 diagnosed with type 1 diabetes strive to maintain an A1C level lower than 7.5 percent. Previously, target blood glucose levels – as measured by the A1C, a test that reflects average blood glucose levels over several months – could be as high as 8.5 percent for children under 6 years of age, 8.0 percent for children 6-12 years of age and 7.5 for adolescents under the Association’s guidelines.  These targets were set because of concerns over complications caused by low blood glucose, or hypoglycemia.

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“The evidence shows that there is a greater risk of harm from prolonged hyperglycemia that would occur if children maintained an A1C of 8.5 percent over time. This is not to say we are no longer concerned about hypoglycemia, but we now have better tools to monitor for hypoglycemia,” said Jane Chiang, MD, Senior Vice President, Medical and Community Affairs, American Diabetes Association and one of the lead authors on the Association’s Position Statement. “The 7.5 percent target is evidence-based; however, we want to emphasize that blood glucose and A1C targets must be individualized to safely achieve the best outcomes.”

I want to urge you to click over to the ADA now and find out more about the changes and the reasons behind them.

Video of the announcement from 74th ADA Scientific Sessioons.

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We've been aggressive with Arden's BGs for the past two years and the results have been nothing but fantastic. Arden received her latest A1c test yesterday and I'll be posting a blog tomorrow about her result and how we've been able to achieved it. 

As the Diabetes Turns

See this picture? I think this was about three weeks ago, may have been a little less but I can't be sure - because I'm exhausted. Anyway, a few weeks ago I was awoken by a screeching DexCom G4 that had this to show me. Since this night, Arden's BGs have been anomalous. They are low for no reason, our insulin to carb ratios aren't correct and every management tool that we use is backfiring. For example, last night Arden ate an entire bagel that didn't require insulin but we of course would have never eaten a bagel without insulin - so her BG got very low. Last Saturday after Arden's basketball game, her BG was 24, yea that was a little scary. We bolus the equivalent of a juice box prior to Arden's participation in competitive sports to combat her adrenaline, basketball is interesting because without the bolus before the game she gets very high but with the bolus, her level (During the game) stays very stable but she needs to eat the minute the adrenaline is gone or the bolus will cause her to get a little low (In the 70s) . Last Saturday however... 24.

Arden has been low each afternoon following lunch and no, before bed BG, seems trustworthy. I've been up all night for, well, I think about three weeks. I'm beginning to get foggy and I can't escape feeling drained and endlessly tired. 

Arden isn't sick, her diet hasn't changed and she hasn't lost weight. Same insulin, same everything - I'm at a complete loss

This will make you laugh. Recently I explained to Arden that one day her hormone levels will change and that her blood glucose will be effected by the change. We spoke about fluctuations that may happen during that time and how we'd handle them.

So the other day she is drinking a juice box for a BG in the 60's that wouldn't budge, when she looks at me super-serioulsy and deadpans, "Maybe its the hormones". I think she was joking...

I'll keep making temporary adjustments to basal rates and boluses until this passes and I don't want to overdo it because you know this is all going to revert back in the blink of an eye. It's like someone sat on the remote and we are stuck watching a bad soap opera until we can figure out whose leg the remote is under.

The BG of 24 is it's own blog post, I'll write that as soon as I can get some rest. Excuse any typos, odd commas or strange turns of phrase... my eyes were closed during much of this. 

Study: Effects of Type I Diabetes on a Young Child's Brain

I'm posting chunks from a recent study that can be found on Diabetes Care (American Diabetes Association) and blurbs from a corresponding article about the study, from Reuters Health. Study text is in the left column, Reuters on the right.

I don't believe that this information should lead you to more worry (Though it likely will) but I do believe that the parents of young children, who live with type I diabetes, should be aware of the study findings. These articles are not fun to read for many reasons, but I found them to be full of the kind of information that helps me to (hopefully) avoid long-term complications for Arden.

If you are currently struggling with BGs or generally feeling down about type I - seriously - bookmark this and save it for a better day - even though you'll likely not find much of the information surprising, it is a somber reminder. My thoughts, are as always, with you and your families. - Scott

Links to the complete articles are included below, at the end of each column. 

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“While many children may not show overt complications from these differences in neural structure, some do have difficulties with processing speed, memory, learning, and complex cognitive functions”

— Reuters Article

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Alterations in White Matter Structure in Young Children With Type 1 Diabetes

Study Objective: To investigate whether type 1 diabetes affects white matter (WM) structure in a large sample of young children.

Results: Between-group analysis showed that children with type 1 diabetes had significantly reduced axial diffusivity (AD) in widespread brain regions compared with control subjects. Within the type 1 diabetes group, earlier onset of diabetes was associated with increased radial diffusivity (RD) and longer duration was associated with reduced AD, reduced RD, and increased fractional anisotropy (FA). In addition, HbA1c values were significantly negatively associated with FA values and were positively associated with RD values in widespread brain regions. Significant associations of AD, RD, and FA were found for CGM measures of hyperglycemia and glucose variability but not for hypoglycemia. Finally, we observed a significant association between WM structure and cognitive ability in children with type 1 diabetes but not in control subjects.

Conclusions: These results suggest vulnerability of the developing brain in young children to effects of type 1 diabetes associated with chronic hyperglycemia and glucose variability.

The entire study can be found here, it includes a significant introduction, an outline of research design and methods, as well as a description of the participants, CGM use in the study, data analysis and much more.

Chronic hyperglycemia, glucose variability may affect children's brains

By Lorraine L. Janeczko
NEW YORK (Reuters Health)

"Chronic hyperglycemia and glucose variability could impact the brains of young children with type 1 diabetes, new research suggests."

"In what the authors call the largest study to date investigating white matter structure in young children with type 1 diabetes, diabetic children had widespread and significant differences in their white matter microstructure compared with nondiabetic controls."

"Compared to controls, children with type 1 diabetes had significantly reduced axial diffusivity (AD) in their frontal, temporal, parietal, and occipital lobes. Earlier diabetes onset was associated with increased radial diffusivity (RD), and longer duration was associated with reduced AD, reduced RD, and increased fractional anisotropy (FA) (all P<0.05)."

"While many children may not show overt complications from these differences in neural structure, some do have difficulties with processing speed, memory, learning, and complex cognitive functions which can be associated with poor neuronal function," she said.

"I believe that these effects could be improved with good glycemic control, although an empirical investigation would help to answer this question. It seems that in the quest to prevent hypoglycemia in children with diabetes, there has been an increase in hyperglycemia in many children. It may be the case that a balance needs to be struck between the two extremes, perhaps with better methods of glucose monitoring."

The entire Reuters article can be found here

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