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At what point is it a "severe" hypo?!

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as i have been type 1 since i was a child i had a lot of hypos , my mum reported to me that my 'passing out point ' was 1.3 , as an adult i tend to have more problems with the hi's now although i have collapsed on a couple of occasions from the low's, i normally gulp down a whole tube of gluca gel if im about 1.4 ish as i know if i dont boom i will be out like a light..anything above 2.0 a bit of lucozade and a couple of buiscits gets me going again
 
ruthelliot said:
Also can I ask what would you say was a good hba1c result for young kids - anyone any idea, and whats too high??
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We were told that 7-9 is good for hba1c. But the nurse also said it is very individual and depends on the stage of the diabetes (we got told that two mths after diagnosis) and the age of the child.
 
Moddey said:
We were told that 7-9 is good for hba1c. But the nurse also said it is very individual and depends on the stage of the diabetes (we got told that two mths after diagnosis) and the age of the child.
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Hi Ira

I'm so sorry but this is not quite right, you have been given duff information by your nurse and its quite dangerous advice as well.

Any HbA1c over 7.5 is considered too high. When you hit the 8 and 9's it is far too high.

It is so very very hard to get good control and get good HbA1cs that lots of docs and nurses say 8's are ok. They are not. There is a study been done recently that continued results of over 7.5 (this includes readings of 7.6 and above) can mean there could be some problems later in life.

However saying that, the HbA1c is not the only way to measure if control is good. You could have an HbA1c of 6.9 but due to too many hypos or swings. If you have a result of under 7.5 and you know it is because of definitely good overall readings then that is great.

We did manage to get my daughter's down to 7.3% when she had been pumping for a year. It shot up when we had a very bad period a couple of years ago and I have been fighting so hard to get her down again to good control. The last result I had last month was a real breakthrough for me and we hit 7.8 % . I strive for that 7.0 or 6.9 but with good results to achieve that and not hypos.

If your child's HbA1c is able 7.5 then your team should be working with you to get it lower.

Please please please don't accept that anything over 8 is an ok reading, it isn't and never will be. Your nurse is wrong. :(

However just a quickie, if your child's HbA1c is over 8.0, please don't beat yourself up about it, things just need tweaking to bring it down. It is not your fault, this diabetes lark is damned hard work for parents (and others of course). 🙂
 
Yes, agree with all! We were told similar early information, but have since learned all Adrienne says.

Saying all that, it is SO hard, especially with growing children. You've got to just press on, but not beat yourself up, if it doesn't feel 'good enough'. It's a marathon type thing, not a sprint...

Most teens struggle hugely with keeping a decent HbA1c. We are doing well so far, but certainly one of our good ones was down to FAR too many hypos. The swings also do their damage, as Adrienne says. So what you are after is a kind of evenness of readings...

We find this impossible at the moment. I'm not sure when it will improve, but we have been chasing and chasing for weeks now: too high, too low, precious few in range. Suspect again that the HbA1c will be fine -- but the swings have been too many. We can but try. Teenagers and hormones wreak such havoc...
 
F felt "slightly wobbly" earlier and turned out to be 1.3. Sometimes she can feel very wobbly indeed and be 5.5... It's so difficult to tell sometimes. Thank heaven for monitors!
 
Gosh that's a low one, hope she is ok now.
 
graham lowest has been 1.3 and the last 6 months average is gone up to 9.5 ill try my best but been so active and the school is difficult is not like reading from a book the consultant they should really have their children with diabetes and maybe they will understand is not so easy
 
We have also had the same scary thing - E's lowest numbers have seemed to have few of the usual signs..... We and he now think this may be because they come on slowly.... V scary!
 
At the risk of showing my ignorance can someone tell me what the dawn phenomenon is - is this to do with increased growth hormone during the night?? Also Adrienne did you manage to get your daughters hba1c that low even when she was younger (a toddler). Ben's last one was 8.4 and we were told we should be really quite happy about this.
 
Hiya

I can never remember what the dawn phenomenen is but I do know that everyone can have it, even non diabetics but with people with diabetes it can have a greater effect. The blood sugars rise quite a bit at dawn so they wake up higher than you think they should.

The Hba1c is a hard one to comment on. When Jessica was Ben's age there wasn't even Lantus or Levemir around. There were only mixes of different makes and kinds. I don't ever expect anyone on mixes to get a great HbA1c, in my opinion mixes need chucking out totally. In Europe they are not used. All newly diagnosed children and adults are either on a pump of MDI (Lantus or Levemir and novorapid or equivalent). Mixes in this country are used for money purposes and I've heard DSN's and consultants say 'it is easier for the school'. That just makes me feel sick and those people need shooting at dawn.

If Ben is on mixes then yep I would be happy with 8.4%. However if he is on mixes then whilst he is young enough, get him changed as quick as you can to MDI. Yes it is more injections but you will be getting greater control which has a huge impact on his health and life in later years. What you do now affects him later. Sorry if this is sounding harsh and if you know all this then ignore me. I hear parents saying they don't want to inject their child more than twice or that their child wouldn't like it, well my answer to that is that their does their child want their eyesight in 15 odd years etc etc you get the drift.

If Ben is on MDI then you can potentially get the HbA1c down a lot lower than that. Your team should have taught your carb counting and what ratios to start at and then help you tweak them. Most people need more insulin at breakfast than tea time.

If by doing all of that you can't get the HbA1c down then the pump is the next thing.

Ad Ben is under 12, if he is on mixes you can skip the MDI stage and go straight to a pump which is hard work but the next best thing to a working pancreas.

Do not always go with the A1c. Ben's is 8.4 which clearly shows he is too high most of the time. However on the other end of the scale if you have a result of say 6.5% that could be because you are having lots of hypos and swings so you cannot always see that.

I think in this country some teams are way behind on care whilst 5 years ago 8.4 as ok on mixes, for long term health it isn't at all. It is early years where you can help to make it a lot better for them in later life. I know you didn't sign up to diabetes when you had Ben, like I never signed up to any of this either but unfortunately for our kids they have it but fortunately for them they have us and we can do great things for them.

Sorry I seem to have gone off on one but I just want to help people. I hope that helps with the A1c.

If you want help with anything I'm happy to help. 🙂
 
Yeah adrienne Ben's on levemir - origonally twice daily but we dropped to once daily about 3wks ago (though our consultant didn't recommend this) and novorapide at meals. His last hba1c was despite a lot of hypos and as we have tweaked things and are now getting slightly less I fear the next one may be higher. We're currently waiting to see if we are getting referred to a different hospital as i'm really unhappy with the advice we're getting just now (I would rather see a paediatric endocrinologist rather than a general paediatrician who once did a few months in endocrinology!). They've had us carb counting from early on though all other dietary advice has been pretty c**p. His ratios seem to change on a daily basis just now and every day we're either getting highs or lows. Been having real problems with midmorning highs (often over 20 , 2 and a half hours after novo) then crashing at lunchtime - have got on top of this to some extent by sticking to one type of cereal cutting out his night time levemir and increasing the morning ratio but he's getting pretty scunnered with shreddies!! My biggest problem is not knowing how good I should hope to get things - I know I am a bit of a perfectionist but I'm sure things could be better. We've been told he "needs the mid morning high" but the thought of him running that high for up to 3hrs every day worries me (and makes for a lot of toilet stops!!) Sorry for the rant - just feeling a bit lost and dissillusioned just now. All advice gratefully received.
 
Don't get down, please, we are all here to help.

Lets start with this mid morning high, to put your mind at ease a bit. Unfortunately this is the same for most. A mid morning spike is horrendous. However there are ways and means of bringing it down again for most. I never could, it was impossible but now we are pumping, it is so much better.

When do you inject the Levemir, morning or night. This can make a big difference. You will find it only works between 16 to 18 hours, so if you are injecting in the morning and he is waking high this is most probably not be the dawn phenonenom but will be the Levemir running out. The only way to stop this is to inject at night but then you may run the risk of hypos overnight as the levemir works best in the first half of its life normally. This is why most people do split the levemir into two injections. If you are unhappy with this, then ask to change to Lantus. Same sort of thing but different company. It does last longer, anywhere between 18 and 22 hours so you could inject in the morning and he should be ok the next morning. We used Lantus.

To combat the mid morning spike and then the huge crashing by lunchtime which come as a pair unfortunately you can try things. The first is to inject the NR about 20 to 15 minutes before he eats breakfast. The NR needs to work before the food starts working. This may help with the spike. I imagine he is waking up high which is helping the spike be much higher. There is already insulin resistence in the morning and waking high will not help at all and you will get the inevitable spike unless you give him an extra shot of NR when he wakes up as well as his breakie shot, which i know you won't want to do and I don't blame you.

On MDI quick food is good, goes against the grain totally but for breakfast you should have some quicker acting carbs than weetabix etc. You should experiment. I know lots of kids have those chocolate wheetos !! Try coco pops, seriously. What should happen is he will go up quickly ie within an hour, and then drop back down again at the two hour mark. This is where snacks for people of MDI come into their own. He will definitely need a proper snack at that 2 hour mark if he is to make lunchtime without a hypo. We used to have to give 15 grams of carbs as a snack, absolutely no fruit at this snack time (unless it is an extra on top of the proper snack). We used Harvest Chewee bars and still do sometimes. Some people find 20 grams is needed. This should have some fat in it, ie biscuits that add up to 15 or 20 carbs, snack bars, toast even but not white ! This snack is sooooo important and will get him to lunch time.

I could go on and on and on but I'll stop for the moment. I hope this has been helpful and its clear enough. Please let me know if I can help. Please don't get down, you really are not alone. 🙂
 
Thanks Adrienne - will continue to muddle on! almost had a day of perfect results today until we got a 3.1 at bed time - Aaaaargh! Maybe tomorrow. I remember my dsn and consultant telling me the week Ben was diagnosed how in a years time it would just be a part of everyday life and we'd hardly give it a thought - seriously? Is that ever the case coz seems like it's what I think about most of the time. Ah well I'm working on perfecting my poker face for his next appointment so I can just smile sweetly and get out before I bite their heads off.
 
I have had literally COUNTLESS medical professionals (including some family) tell me/us that within a year it will be 'second nature'. It always makes me want to shoot them.

And shows their ignorance, or unwillingness to look and see.

It gets easier, I'm sure. But I'm not convinced that it ever gets easier than it is now for us. My son was diagnosed the same month and year as yours! The pump has been life-changing, etc... But second nature?! No way.
 
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