Today we had out first A1c where all the time was spent in full puberty mode (for our last A1c, only half the time was spent in puberty mode). I was expecting something in the 6s but I was taken aback by the results: 5.4% (our last two were 5.4 and 5.3 in chronological order).
I am not 100% sure if the number is fully true, since my son has gone through a good number of lows in the mid-50s: I understand that deep lows can de-glycate hemoglobin (@Chris, you had some references on that recently?). I am not sure if these lows would have been enough to do so.
However, even if the “real” A1c is a bit higher, this really cheers me, because it means that it is possible to maintain a decent A1c during puberty. So, as a data point, I am sharing how we have changed my son’s diabetes management since he entered puberty. We have only been at it for 6 months, so this is a work in progress
We have lowered our aim point from 120 to 100
We have adjusted our acceptable range to 70-120 from 80-150
We have decided to live in what we call “the lower half of the range:” if we are significantly in the upper half of the range (100-120), say, above 105 or 110, we inject to go to the lower half (70-100)
We changed the way we make decisions on insulin injections. We used to often wait for a few more points to make sure of a decision. Now, the moment the BG crosses 120, we “decide and inject,” assuming that we will get to a certain level (typically assuming 180), then keep on injecting more if we hit the level we were aiming for.
We also routinely stack, with caution. My son’s insulin activates after 40 minutes. If, after 1 hour 20, we don’t see significant corrective action, we stack – again, carefully. For instance, we had a particularly resilient peak 2 weeks ago – we stacked 5 injections on a row every 60-80 minutes to get the peak down (rare case though). FYI, my son’s DIA is about 5h 20.
What is the price we are paying for this? We had a stretch of several months where we were hitting too many lows in the mid-50s. We have worked very hard on it, and are still working on it – we still need to improve there. As a reference, over the past 2 weeks, we have spent less than 1% time below 60, and about 6% time below 70, per the Dexcom (although some of that is an artifact – the real numbers are less). Still, we have more lows than we used to before puberty.
At the same time, we have improved our % time low, and know how to do it better – we just have to practice it. So, imho, in the end the % time low will be quite low, and the real price to pay will be sleep time – my wife and I spend a lot of time up at night regulating the boy, so that he does not have to trash his nights and be tired in the morning. I’d say we average 3 alarms per night, low or high – for many of which you have to stay up 1.5 hours or more, to make sure, for instance, that the high is properly treated.
So, in the end, I think the primary cost is sleep, and it is a significiant cost – bad enough that we have to take turns: a week of it puts me on my knees :-). This limited cost is true only as long as the boy is willing to do the routine. When that changes, all bets are off.