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From Laguna Beach, California, USA:

Our daughter, who has had type 1 for 10 years, has struggled mightily with her A1c. Her current complaint is that bringing her A1c down will result in her gaining weight. More insulin equals more weight. We are trying to convince her that a proper balance of food intake, exercise and insulin will not necessarily mean higher weight. Do you have any ideas to help drive this important point home? She is comfortable with her A1c at 11 or 12!


You are so correct on so many levels and correct to be so concerned.

The optimal balance of insulin, exercise, and food intake remains the key in proper glycemic control in diabetes."Settling" for a HbA1c of 11 to 12% is no settle at all as it vastly increases risks of major health issues in the future. As an adult, you can foresee or appreciate that, but a teenager with the short-sighted vision of "invincibility" usually doesn't see much past next week.

It is also true that the "easiest" way to manage higher glucose values is to throw more insulin at the problem: dietary measures and exercise take more commitment. But, insulin in this manner leads to easier weight gain (or more difficult weight loss). So, you need to talk to your daughter's own diabetes team about strategies to help her enhance the effectiveness of insulin and decrease insulin doses, if possible, yet improve the HbAic value. The BEST way is a structured exercise program. Exercise enhances the effect of insulin on the body so you can use less insulin for the same effect. It doesn't need to be Olympic caliber exercise. A daily walking program, bike riding, or swimming will help. Personally, I'd suggest you enlist the help of a trainer, if you can afford it, because a good trainer can encourage and motivate and it is perceived differently than the nagging of a parent. This could be at the local YMCA facility or similar.

You may wish to have a dialogue with the endocrinologist about your daughter's potential use of two different medications. One, metformin (when used carefully with a lower (not "NO") carbohydrate diet can decrease the doses of insulin and enhance muscle sensitivity to insulin to a degree; the other, Byetta might help but it is an off-label use in Type 1 diabetes. It is expensive and is also given by injection. Metformin comes as a pill (or liquid).


Original posting 29 Jul 2009
Posted to A1c, Glycohemoglobin, HgbA1c and Daily Care


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