The HbA1c we aim for in this country for children is to be below 7.5% though this is actually lower in other countries at 6.5%. It is a simple graph when you look at complications compared to HbA1c, the higher it goes the more at risk you are of long term damage. The lower it goes the more at risk you are of severe hypos.
It is a matter of balance really. I aim for the 6's but I have only been able to get my kids HbA1cs in the 6's since using a pump and continuous glucose monitoring. Before that they would only be in the 7's with hypos thrown in too often to be happy. To be in the 6's then they would have had to have lots of hypos which wasn't acceptable.
Since using sensors I have found the key thing is to avoid prolonged periods of higher levels, meaning any levels over 10 for longer than a couple of hours. At the moment it sounds like you are not sure where the problem areas are, so you could ask your supportive team to let you try a CGMS (continuous glucose monitoring) for a week so you can see where the problems lie. This would help immensly before going onto the pump, if that is the way you wish to go. However, your HbA1c is bordering on the good range so it may be you are happy with this for the time being and the age/activity level of your son.
At the moment very few childen have the recommended HbA1c; under 30% get HbA1cs under 7.5 but what is even worse is how many spend years and years with HbA1cs over 8/9/10 etc. Discussing this nationally has clinicians scratching their heads. Mainly it is felt we lag behind Europe because we fail to express the seriousness of diabetes at diagnosis to families and patients, the expectations of teams are not high enough for the control which can be achieved, children being kept on mixed insulin when they need MDI or insulin pumps, a lack of on-going education for patients, families and clinicians and perhaps most shocking, that clinicians being put in charge of paediatric diabetes have no diabetes knowledge and DSNs do not have to have any diabetes training at all, only a level 6 nursing qualification so the uniformity of the teams expertise across the country is not good.
There are things happening to address all these issues but they cannot happen fast enough for some areas. It sounds like you have a clinic where you can ask for more input which is just great. Many areas do not have even that basic support sadly.
Paediatric diabetes only gets 1% of the entire funding pot for Diabetes in this country. This will be changing but plans have been somewhat held up by the change of government. Hopefully this will improve - let's face it, it has to!!
