From Keyser, West Virginia, USA:
My 10 year old son has had type 1 diabetes for five years. He has been on an insulin pump for four years. We test between six and 10 times a day (testing once in the middle of the night). We keep very detailed records of his care (blood sugar results, carbohydrates eaten, units used and log them on a monthly spread sheet in a very detailed format). His doctor doesn't seem to think that A1cs are very important. We only have them done when I insist and insist and almost demand it. We also have never had a urine protein test done, although I have asked for one. I don't understand this. I want to take the very best care of my son so that I can to try to avoid future complications. I really like this doctor, except for this. My husband says that the doctor knows what good records we keep and that is why he doesn't feel that they are important. I need to know; should we be having them done and how should I handle this with the doctor? His last A1c, a year ago, was 7.5.
This is an interesting situation. While it may be true that one gets a ton of information from frequent blood glucose checking, and frequent checking does correlate with good glycemic control (based on A1c determinations), home glucose monitoring does not take the place of A1c testing and A1c testing does not take the place of home glucose checks. They complement one another but they are not the same.
I admit that I am a little (or, more than a little) surprised that your child's doctor "does not believe" in A1c determinations. Furthermore, for a child to have diabetes for more than five years and not to be screened for potential complications and co-morbidities is, I think, wrong. For example, there is nearly a 20% incidence of thyroid problems with type 1 diabetes; there is nearly an 8% incidence of celiac disease with type 1 diabetes. Lipid levels, urine microalbumin, formal eye testing, and even screening for adrenal problems may be worthwhile.
In your state, the pediatric endocrinology options may be limited. But, I strongly urge you to have a dialogue with your child's diabetes specialist (is this person a pediatric endocrinologist? If not, that might be the answer. Perhaps this person is more comfortable working with adults with type 2 diabetes).
I do find it very odd that the child has been prescribed intensive, expensive insulin pump therapy but is not being followed for standard A1c testing. Sometimes insurance companies will dictate to a provider that certain things have to be measured to allow continued authorization of medical therapies.
Talk with your doctor or get a second opinion. Finally, what's to stop your primary care physician from being part of the dialogue? Get your pediatrician to advocate for you and get the appropriate things done.
Original posting 27 Jun 2006
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