NEW A1c guidelines from the American Diabetes Association
The American Diabetes Association just announced their new position on A1c targets, for children under the age of 19, who live with type I diabetes. What follows are snippets from the ADA story.
The Association now recommends that children under the age of 19 diagnosed with type 1 diabetes strive to maintain an A1C level lower than 7.5 percent. Previously, target blood glucose levels – as measured by the A1C, a test that reflects average blood glucose levels over several months – could be as high as 8.5 percent for children under 6 years of age, 8.0 percent for children 6-12 years of age and 7.5 for adolescents under the Association’s guidelines. These targets were set because of concerns over complications caused by low blood glucose, or hypoglycemia.
“The evidence shows that there is a greater risk of harm from prolonged hyperglycemia that would occur if children maintained an A1C of 8.5 percent over time. This is not to say we are no longer concerned about hypoglycemia, but we now have better tools to monitor for hypoglycemia,” said Jane Chiang, MD, Senior Vice President, Medical and Community Affairs, American Diabetes Association and one of the lead authors on the Association’s Position Statement. “The 7.5 percent target is evidence-based; however, we want to emphasize that blood glucose and A1C targets must be individualized to safely achieve the best outcomes.”
I want to urge you to click over to the ADA now and find out more about the changes and the reasons behind them.
We've been aggressive with Arden's BGs for the past two years and the results have been nothing but fantastic. Arden received her latest A1c test yesterday and I'll be posting a blog tomorrow about her result and how we've been able to achieved it.
NPR: Father Devises A 'Bionic Pancreas' To Help Son With Diabetes
So many times I tell people, "You'd have to live with us for a few days to really understand type I diabetes".
NPR posted a wonderful audio interview with Ed Damiano, the man who is working on the 'Bionic Pancreas' at Boston University. I've embedded Rob Stein's report here for you to listen to... after you're finished I encourage you to head over to NPR's site to read the entire interview.
Image by Ellen Webber for NPR
DexCom’s Forthcoming Mobile App Platform to Integrate Data from Insulet’s OmniPod System
Well, well... This sounds like a positive step!
From Market Watch...
SAN DIEGO, Jun 13, 2014 (BUSINESS WIRE) -- Insulet Corporation and DexCom, Inc. announced today their intention to enable DexCom’s mobile App platform, which is currently under development, to integrate data from Insulet’s OmniPod System. This will be the first version of a mobile App that is capable of incorporating glucose and other diabetes-related data from patients’ devices and displaying the integrated data via a smartphone App. This event also marks the start of DexCom's open architecture approach to diabetes-related data which will include an “approved by DexCom” indication to validate the authenticity of devices and Apps integrating DexCom CGM data.
“Providing OmniPod users and their healthcare providers with easier access to their management data is another key step in making diabetes a smaller part of life,” said Duane DeSisto, President and Chief Executive Officer of Insulet. “Through DexCom’s mobile App platform, OmniPod users will have greater access to the data that is so essential for understanding and improving diabetes management. We are proud to help people with diabetes gain greater and easier control over their disease and we remain dedicated to providing advancements that further this mission.”
“More than ever, we believe that effective diabetes management depends on timely and accurate data. That is why we are excited to complete development of the App and integrate data from Insulet’s OmniPod system,” said Terry Gregg, DexCom’s CEO.
Read the entire announcement here.
Living Between the (Diabetes) Lines
Three questions that every person living with diabetes asks themselves...
How high is too high? How low is too low? How do I find the balance between long-term complications and having a seizure.
Each of us has been given a range to aspire to. When Arden was first diagnosed, the doctor told us that we should be trying to keep her blood glucose value between 110 and 200 - "let's try to keep her A1C under 8.5", they said.
And so that became my goal.
Then one day they told us that we should lower the high range value to 190, at our next visit we agreed to try 185. The low range number was never touched. I understood what was happening even though it was never articulated to me, our BG goals were adjusting based on the vibe that our Endo got from us at each visit. She was evaluating our ability to handle spikes, lows, meals and overnights. I was being lovingly manipulated.
Then one day we discovered CGM technology and that little screen gave me something that I never had before, a visual representation of our goal. Now there was a line that I was trying not to cross. In the past when our goal was 190, 210 didn't seem like a huge miss and on the low end... even though we were trying for 120, 100 seemed so perfect that we didn't mind being a little low; besides many people, who don't have diabetes, regularly have a BG of 85 - of course they don't have man-made insulin in their system that doesn't know when to stop removing sugar from their blood.
I was living between the lines but I think the lines were holding me back...
I say holding me back because Arden's BGs were, for the most part, existing between them. I'm not talking about unforeseen spikes or unexpected lows. Highs and lows happen, you correct and move on, but you don't let them impact your impression of the graph. A few blips don't discount the rest of the day. Look at how the BGs are when you are blousing correctly, counting carbs accurately, when your basal rate is properly set. In those hours I was content if the graph line was mostly stable and in between 180 and 120.
It took me quite some time to figure this fact out, but the comfort that I felt when we achieved BGs that were between those lines, was holding me back from trying to do better. I had been lulled into a state of acceptance.
The lines were also providing a false sense of security. Even though they were arbitrarily set by a person that I only see four times a year, I was treating them like gospel. Finally I wondered, "if I can successfully keep a BG under 180 why could't I keep it under 170? Hell, why couldn't I shoot for 140?".
So I moved the line and do you know what happened?
I kept her BG under 160. Then I got brave and moved her low threshold to 100. Today, Arden's low alert sounds at 85 and her high is set at 160, but this summer I'm going to move that to 150.
All of this doesn't work if you punish yourself for going outside of the lines. I am telling you, do not do this if you can't handle seeing the graph climb above, or below those lines - don't add stress to your already stressful day. Before you attempt to move the lines you must find peace with being on the other side of them, you have to come to grips with the idea that nothing in life is controllable to that degree. Here's how I found my peace with that truth.
I was happy if Arden's BG was 180 all day because someone told me that number was okay. Her BG still spiked, it still got low but for most hours of each day her BG was 180. Today, most hours of the day come with a BG of around 140. She still has spikes and still gets low but most hours are spent in our new range. It took me a while, but now I can see, there is no difference in how I manage or what I do; the only thing that has changed is my expectations and the way that I react to them.
When I expected 180, I got 180. When I expect 140, I get 140. I'm learning to except 90... one day I'll learn to expect it.
When you're ready, move those lines... the ones on your CGM or in your log book, and the ones in your mind and heart. Expect what you want, except what you achieve and never stop moving the lines that life sets. Define your own reality.
Don't forget to read my disclaimer, I am not a medical professional and I am not dispensing advice... just telling stories on the Internets, the WWW, the information highway - you get what I'm saying. Please also don't forget that high and low ranges are never one-size-fits all. While Arden feels fine when her BG is 85, you or your child may not.
Rainy Days and Mondays have nothing on Diabetes
The topic for day three of Diabetes Blog Week is 'What Brings Me Down'...
Check out all of the entires for Diabetes Blog Week
My 'What brings me down' post is based on the last twenty-four hours...
It brings me down when diabetes causes the rest of my life to get put on hold...
It brings me down to have to call the parent of one of Arden's friends to explain diabetes...
It brings me down when they don't seem to understand...
It brings me down when I find myself speaking, about the things that person will need to do if Arden is to attend an event, in an apologetic tone...
It brings me down when I realize that the weight of my message wasn't felt...
These things bring me down because it is completely understandable that a diabetes novice wouldn't understand.
It brings me down that Arden's diabetes technology always seems to provide a let down in these situations...
It brings me down when a pump site fails at the most inopportune moment...
It brings me down that the time I was trying to spend with my son got cut short because of the site change...
It brings me down when I have to change a pump in a car...
It brings me down when I have to inject because the pump site failed...
It brings me down that it feels like every time a DexCom sensor fails to keep up with Arden's BG, it's during a moment like this...
It brings me down when I think I'm fighting with a stubborn 200 BG and it's really 430...
It brings me down when Arden doesn't feel well because of that 430...
It brings me down that in the middle of writing this I'm texting with Arden about a rising BG...
It brings me down when Arden feels sick from her BG while she is trying to play softball...
It brings me down when my wife texts me to say that she seems to be struggling because of it...
It brought me down that I wasn't there...
It brought me down when it took me too long to mentally get back to my son...
It brings me down when my wife called me as I was coming home to tell me about a bad BG incident that happened while I was cheering at a baseball game...
It brings me down when Arden is unsafe...
It brings me down when her BG drops so fast...
It brings me down when I look in my wife's eyes as see tells me about it later...
It brings me down to see my family sad...
It makes me happy to write about it here.
Because today is a new day.
Because everyone is fine.
and will be fine.
It's makes me happy to tell you that this was just a bad day, just an unlucky collection of coincidences...
Diabetes can bring you down sometimes but there is no rule about how long you have to stay down. In many ways living with diabetes is like the graph on your CGM screen. Steady mostly, with down and up moments. Some highs last longer than others, some lows hit you hard and some come and go. I guess that most everything in life could be described with those words.
#DBlogWeek