Changes in the A1c, and chances my other kids will develop type 1 diabetes

Dear Dr. Penny,

My 15-month old was diagnosed 2 months ago. I’m terrified and still in shock. Any advice for us? 

Also, I was reading about the change in the range of the A1C and I’m a little scared, our child’s doctor told us that for his age the A1c should be 8.5% and slightly higher glucose, obviously, he still can not identify hypoglycemia, we are expecting the insurance company to respond to us about the Dexcom. It is this right? 

Is there any evidence that my other kids can develop type 1 diabetes? I met a mom with 3 kids with diabetes, it really scared me. 

Dear D-mom,

I can imagine how you feel as this is such a new diagnosis, believe me I empathize with your feelings and with your family, and I want to let you know that you’re not alone! As many of the families who are part of this community can corroborate, in some way or another, things do improve. The fear never goes away, but things get easier, for now, we just have to learn to live with it. The more you learn, read and participate in the care of your child, the stronger and capable you will be, only time and education help.

In cases like in your family, with young age at diagnosis, management can be challenging, even for us the physicians, as we also fear for hypoglycemia, and it would be difficult for your baby to communicate signs or symptoms of feeling “low” and in cases, there is the risk for even a hypoglycemic seizure. So this is one reason we prefer to maintain higher glucose targets than in older children. In some instances, in order to be more precise with my dose, I have chosen to use diluted insulin administered via injection (Careful, I mean that the pharmacy makes these dilutions, PLEASE discuss this with your endocrinologist).

I think the Dexcom is a wonderful tool because it allows us to identify patterns, what this means, is that in general, glucose monitoring will suggest  when there are changes in glucose levels, either high levels or low. However, let’s remember that using the Dexcom does not mean that we no longer use the glucometer, since the Dexcom does not use blood, but interstitial fluid (fluid from around the cells), and there may be a difference of 40-50 points when compared with the glucometer.

In regards to glycated hemoglobin A1c, a couple of months ago, the goal was 8.5%, but the ADA recently launched a new recommendation, where anyone younger than 19 years should have a A1c of <7.5%.

What also would be ideal in a young patient, is believe it or not, an insulin pump, as he can receive a continuous administration of insulin, but also we can manage to deliver micro doses of insulin, and different doses of  basal insulin, which  would replace the long-acting insulin you use (Lantus or Levemir) where he receives the same amount every hour of the day.

Regarding your other children, although they could be screened for diabetes by drawing  antibodies, if these are positive or negative does not guarantee that the diagnosis is imminent or on the other hand, are exempt if you are negative.

Good luck with everything and I hope my answer has helped you,

Happy numbers!