Oh the most recent A1c value I have for him is from July and it is 9.4 (A) H?? This value is something no one has ever spoken to J and I about. What is it? The next time we find this value out will be in Feb. I believe....
A1c's are typically taken every three months. Basically, an A1c is an average of blood sugar over a three month period. Three months is the average life of red blood cells. An A1c of 9.4 translates to an average BG of 223. Since it's an average, he's been above this number & below it. A 9.4 is a very high A1c.
Hey there!
Kudos on doing a great job! I just wanted to state the obvious, that until you have custody, you are going to see a see-saw on his readings. Going constantly from high to low can cause both reactions to be more extreme, ex. the highs will be worse, and so will the lows. If you can gain custody and give him consistent treatment, you should see the pattern level out a bit as one lifestyle becomes predominant for him.
Keep up the good work and hope you get him!
With regards to fruits, I think they can be a good part of a Type 1 diet, but you just have to figure out which ones work and which don't. Fruit in twist or strip form is probably going to work just like candy with a fast, big spike. More whole fruits could have a slower impact on blood sugar. For example, apples are practically a miracle fruit for me. I can eat a whole apple, take insulin for it, but not have a spike at all. If I ate the same amount of carbs in strip form, I would definitely have a big spike. It sounds like you guys are doing a great job figuring out what works and what doesn't for him though. Good luck! This is a great place to get support! I truly hope things work out for you all and that your little one can get what is best for him! Hang in there!
Aand J, I'm glad you gave an idea of D's diet. A child gets used to being treated differently by 2 sets of parental situations. Over time he will respond best to your kindness, and he will shy away from freaking out. The endo is doing what she has to do. She is keeping focused on D and his needs. A dietitian can't bill for giving the same information twice. So you can expect to have to learn diet from scratch. Grams of carbs raise BG most. 50% of protein over 3 hours changes into glucose. 10% of fat changes into glucose over time, too. So BG will be high 3 hours after a pizza slice and require a correction dose of insulin.
The tables say that 1/2 gram raises a 40 lb person 10 mg/dl. So 1 gram raises D 20 mg/dl. 15 grams raises 300 mg/dl - on top of wherever he is. If he's at 100 mg/dl and he raises 300 mg/dl on 15 grams, he's at 400 very quickly. To level this out, 4 or 5 meals, spaced apart, of 7 grams carb and including protein can keep the BG from going so high. According to this, 8 Gm would raise BG 160.
Try a small meal out - note its grams, see how far it raises, and see how insulin will pull it down. You can start making a record of how far insulin brings it down when you get numbers that aren't quite so high. The BIG problem is that when BG goes above 200, insulin resistance takes hold. Small meals are a real boon here. 1 cup milk is already 12 grams! Give 2/3 cup in order to try this out. Give it by itself. Two hours later try another 8 gram meal. (The Endo will catch on. You don't have to tell an endo what's happening.) The idea is to get BG sl-o-w-ly down, not dropping like a thud. Actually D can't tell you, but he will get those feelings of hypoglycemia at a higher place as he is coming down. And D will catch on to the meals, too, if you plan some out for a weekend. I take it you know all the gram amounts for cereals, fruit, milk, and starches.
I take it you know that the Lantus doses should be keeping him in the target zone between meals and overnight, not lowering him between meals to a hypoglycemia. The endo will, of course, note that between meals, the BG is at a certain place, so there is no need for a phone call unless hypoglycemia occurs when you have done no correction with short acting insulin for a high. If D loses weight, the Lantus dose would require lowering. My guess is that as he becomes an active toddler, he won't lose weight, he will slim out.
Best wishes!
For an adult, this would be really high. For a child, this is high, but not REALLY high. Children typically do run higher because of growth hormones in their bodies. I/My parents were always told, until I hit puberty, that a goal was 8% or under. For adults, depending on who you ask the goals are typically 7% or under (ADA), and many go with goals well below that. A non-diabetic ranges between about 4-6%.
It does sound as if you and his Dad are doing well with him. I hope you are able to have more time with him. No excuse for the endo not speaking to you and his Dad, you are a caretaker and Dad is a custodial parent. Insist on meeting with the endo, privately, if necessary. The lower numbers when he is on your watch could either be for diet or he gets more exercise. Excercise does not have to be strenous to cause big changes in blood sugar levels. Just walking around can have a dramatic effect. It is entirely possible the Mom may be feeding him extra carbs because she is afraid of the lows. Hopefully, this will change once she becomes more comfortable taking care of him. I know it is very difficult taking care of a toddler with diabetes, and you will have to be able to speak to the endo to get the proper advice. I think it is dangerous not to have access to his diabetes team. You should be able to call them in emergencies and in general and fax or phone in problematic numbers to the CDE so she can help you adjust food and insulin, especially in the beginning. Much harder to take care of a baby or toddler than it would be taking care of my niece, who was dx'd at 8. Entirely different ballgame. Hoping you can get through to that endo..... In answer to your general questions: We did not determine the amount of carbs she ate per day in the beginning. The nutritionist at the hospital did. The carb amounts are based on appropriate amounts for the age of the child in order to facilitate proper growth. We were also given a meal plan, spacing out her meals/snacks and we did not modify it in the beginning. Now she eats flexibly but still does stick to a general meal plan, and spacing of meals. Which can be changed occasionally. She used Novolog and Lantus; shortly thereafter insulin pump with Novolog; now pump with Apidra. I think the lower carb amounts you are listing is because you have a baby and babies don't eat as much as the older child. Yes, if you give too much food, the child will gain weight. In our case, never overweight; always, and still now, underweight. P.S. I do notice even on the correct basal insulin amounts, if she does not eat during the day for five hours, she will drop. Possibly due to exercise, but we do have three meals and one snack, evenly spaced, if possible. This is not supposed to be necessary.