# First successful A1c in puberty **URL:** \ **Category:** Teen\ **Created:** [June 28, 2017, 6:17pm UTC](https://forum.fudiabetes.org/t/first-successful-a1c-in-puberty/1338 "2017-06-28T18:17:37Z")\ **Posts on this page:** 6\ **Page:** 1
**Author:** ![Michel](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/michel/32/387_2.png) [@Michel](https://forum.fudiabetes.org/u/Michel)\ **Post date:** [June 28, 2017, 6:17pm UTC](https://forum.fudiabetes.org/t/first-successful-a1c-in-puberty/1338/1 "2017-06-28T18:17:37Z")
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](https://forum.fudiabetes.org/t/when-cgms-lie-and-when-a-deep-low-is-really-a-nice-landing/1336/) – 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. ---
**Author:** ![docslotnick](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/docslotnick/32/75_2.png) [@docslotnick](https://forum.fudiabetes.org/u/docslotnick)\ **Post date:** [June 28, 2017, 7:04pm UTC](https://forum.fudiabetes.org/t/first-successful-a1c-in-puberty/1338/2 "2017-06-28T19:04:43Z")
> [@Michel](#): > > 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 That’s awesome @Michel and @Kaelan! The plan you are using is remarkably like the one I follow, and it seems to have served me well. Really the only difference is I keep my upper limit at 140. And isn’t it funny that our A1c’s are fairly similar (mine was .2 higher). Keep up the good work, and welcome to adulthood! ---
**Author:** ![ClaudnDaye](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/claudndaye/32/5_2.png) [@ClaudnDaye](https://forum.fudiabetes.org/u/ClaudnDaye)\ **Post date:** [June 28, 2017, 8:49pm UTC](https://forum.fudiabetes.org/t/first-successful-a1c-in-puberty/1338/3 "2017-06-28T20:49:49Z")
Awesome guide! I can see definitely referencing this in the future ourselves. Kudos to you guys for this AMAZING A1C! ---
**Author:** ![Chris](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/chris/32/382_2.png) [@Chris](https://forum.fudiabetes.org/u/Chris)\ **Post date:** [June 28, 2017, 10:31pm UTC](https://forum.fudiabetes.org/t/first-successful-a1c-in-puberty/1338/4 "2017-06-28T22:31:31Z")
Nice job Michel, glad to see you are back. ---
**Author:** ![Irish](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/irish/32/57_2.png) [@Irish](https://forum.fudiabetes.org/u/Irish)\ **Post date:** [June 29, 2017, 2:58am UTC](https://forum.fudiabetes.org/t/first-successful-a1c-in-puberty/1338/5 "2017-06-29T02:58:24Z")
This is thrilling news! Bravo, team!!! Your hard, hard work is paying off, @Kaelan @Michel! And so good to know you didn’t get an undeserved lecture! It’s so exhausting to work so hard and then to be told you’re doing it all wrong. Simply crazy-making. And dread-inducing. Hopefully, with your continued success, you will be able to educate them along the way. ---
**Author:** ![Michel](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/michel/32/387_2.png) [@Michel](https://forum.fudiabetes.org/u/Michel)\ **Post date:** [June 29, 2017, 3:49am UTC](https://forum.fudiabetes.org/t/first-successful-a1c-in-puberty/1338/6 "2017-06-29T03:49:08Z")
> [@Chris](#): > > glad to see you are back. @Chris, so sorry, I am not really back:( I am leaving again tomorrow, will be off-grid for a week again. I splurged on FUD while I was home today!