Hi, I am a Greek medical doctor and I am new in this forum. I am providing care for a child with newly diagnosed type 1 diabetes, and I would like to ask parents how quickly you reached your A1C target after your child was diagnosed? What was your A1C after the first 6 months?
Also, any tips and tricks for better glucose levels in the first postprandial hour? Do you try to be within target in the first or the second postprandial hour? Thank you!
hi @czavos, welcome to Type One Nation.
a gentle reminder, this is not the JDRF, this is a self-help forum of people who have type 1 diabetes. Most of us here aren’t doctors. We always try to avoid medical advice. That being said, the onset of diabetes in children is often accompanied by a period of time where most of them make insulin again (called “Honeymoon”). therefore during the first 6 months the hba1c comes down very fast and it is common for glycated hemoglobin to be Normal (4.0% -6.0%) when it is first tested after diagnosis. Mine was 5.5% in 1980 after about 7 months of T1. I’m saying this because, (in my opinion), it’s not a fair question. A different question might be regarding a1c control and hypo and hyperglycemic events after the first 9-12 months when medical supervision is reduced. Do you have access to specialists, such as pediatric endocrinologists near your location?
Thank you for your answer… I may be a medical doctor but I do not treat patients with diabetes. This is why I asked for your experience in this forum, since such experience cannot be found in the literature. Of course I am aware of the honeymoon period, but sometimes it is rather more difficult to reach your target A1C during that period, since production of insulin by the pancreas can make it more difficult to calculate the insulin dose you need to administer. Of course I have access to specialists in my location.
@czavos Oh, no offense intended - the top 20 contributors here have about 500 years experience treating their own T1! Im happy to talk anytime! it’s been my experience that if you make even a little insulin, the a1c improves, since you clip the top of most post meal blood sugar rises and have better overnight control, probably the typical reaction is not injecting or avoiding injecting enough insulin. Yes it is very tricky, but when you make zero insulin, post prandial spikes are very difficult and overnights are riskier because you have to take quite a bit of insulin. The overall requirement of basal is more controllable on an insulin pump or you have to deal with the relentless absorption of long acting insulin without being able to stop it or slow it down.
this is only my personal experience. A1c control degraded after that first year due to the end of honeymoon, and the beginning of post-traumatic depression. We also didn’t have blood sugar meters and so the detectability of my blood sugar was: I could tell if I was very high, by urine sugar, Everything else was “by feel” until they invented home blood glucose meters. I probably had a1c of 8-10% as a teenager until I made a conscious decision to take better care of myself.
Thank you for sharing your thoughts and experience… fortunately times have now changed with CGM. Let’s see what the experience of the parents with children in the present time is.
I still have the logs, so I actually know this. 
A1c at diagnosis: 10.6
At 1 month: 8.9
3 months: 6.7
6 months: 5.8
9 months: 6.8
12 months: 7.3 (honeymoon’s over 
)
This was with injections, and no CGM. And to Joe’s point, our daughter was 6 when she was diagnosed. We gave her a lot of responsibility, relatively speaking, but still, the decisions were much more ours than hers.
As far as minimizing after-meal spikes, I don’t know any tricks, but prebolusing makes a huge difference. Depending on the age, though, this might not be a great idea. You wouldn’t want to bolus for the whole meal only to have the child refuse to eat. Exercise makes a tremendous difference, too — even just a short walk after eating helps. Quantity and quality of carbs matters (huge bowl of white rice versus small serving of brown rice, for example); what else you’re eating matters (lasagna is going to be slower than penne primavera); and the order you eat it matters (roll, mashed potatoes, green beans, chicken will spike more than the exact same dinner eaten in reverse order).
I think the goal is to always stay within target range, but that’s easier said than done. 
I was diagnosed early. I barely needed any insulin in my first year, and A1C was normal. I was at or below 6 for my first year, I think. Gradually it went up to about 7 and stayed there for 20 years. When I switched to a pump, it went down to about 6.3-6.5. Over that time, I’ve switched insulin brands and types multiple times, gone from taking about 10 units a day to nearly 100, and had to make educated guesses about all sorts of things.
But it varies a lot. Depends on the particular patient. How much of their insulin production capacity was left when they were diagnosed? How quickly are the remainder of their beta islet cells being destroyed? How well are they taking care of themselves? How much do they exercise? What do they eat? What other medical conditions do they have? Are they taking any medications that could affect BG or insulin sensitivity? Are they going through puberty and/or growth spurts?
T1D is a highly individual condition, with so many contributing factors to BG control. And the honeymoon period is particularly unpredictable.
It’s not about what’s “typical.” You won’t find an average patient any more than you’ll find a family with 2.5 kids. Managing T1D is about taking it as it comes. Where is the patient right now? What’s going on in the patient’s life? How can we make things better for the patient without constraining them with unrealistic and stressful constraints? How do we balance the patient’s individual needs? What carb ratio works best for this patient? A lot of it is trial and error, and it needs to be adjusted on an ongoing basis.
Don’t worry about what’s typical.
As for BG levels after eating: Taking insulin before the meal so it can have time to absorb and start to work can help. Match the curve of insulin activity to the curve of food digestion. Watch what you eat and plan for it. Adjust dosage and carb ratio. Get a feel for what works without risking lows.
I used to have a glass of milk with breakfast every morning. I took insulin to cover. My lunchtime BGs were always fine. But when I got a CGM I noticed that the milk was spiking my BGs for a couple of hours mid-morning. The lactose kicked in and then faded away by lunchtime, and we hadn’t accounted for that. So I switched to sugar-free drinks and my levels evened out. Of course, if not for my sleeping disorders, I might be more active in the mornings, and then that sugar would be burned off and might even be beneficial.
(This is why switching from exchanges to carb counting always irritated me. Carb counting oversimplifies everything. Simple sugars, complex carbs, fats, proteins… They all digest differently and have different uses and nutritional values. In my head, I still try to stick to exchanges even though my pump only understands estimated grams of carbs. Having the flexibility for snacks, special occasions, etc. is nice. But overall a healthy balanced varied steady diet is important for BG control and meeting nutritional needs. As with most things, it’s a matter of finding a good working balance: In this case, the flexibility to live day-to-day life, adapt to what’s going on, and not feel overly constrained to a stressful and repressive degree vs the need to have good BG control and a healthy diet. See where you can get those to align, and then find a workable balance between conflicting needs so that they’re all being met to a reasonable degree. And then adjust as necessary when circumstances change.)
Good luck with your new patient. You’ll both get the hang of things with experience. But it’s good of you to reach out, use available resources, and learn from patient experience. Some doctors just go by the book and dismiss patient knowledge, particularly if it comes from online spaces, and in doing so, they do themselves and their patients and unfair and unnecessary disservice. Thank you for keeping an open mind and acknowledging your limits and gaps. That’s a great start.
Remember, you can direct your patient to us, as well, if they need additional support and advice.
Thank you for your encouragement… I agree, it’s easier said than done. And learning from experience is more important than following any kind of guidelines.
I am amazed that it matters the order you eat food. It is so interesting. The daughter of my best friend has type one and we are writing a children’s chapter book series where the main character has type one. I love to learn as much as I can from all you amazing parents to help me make the characters as realistic as possible. I will be including food order in one of the books. Thank you for the tip.
It’s all about matching the curves. How fast is the glucose entering your bloodstream, and how fast is the insulin acting to get that BG into your cells? Eat all your fast-sugars first, and your BG rises faster than the insulin can act. Eat all your low-carb, slow-release foods first, and the insulin brings you low faster than the glucose can get there to meet it. And of course there are a LOT of other factors that influence BG and insulin absorption, so, um, yeah. Always a challenge. But we do the best we can.
I did not know it either that food order really matters… but it makes sense. Good luck with your book!
Same here. 11 yo son went into great range within 6 mos but it fell apart again after honeymoon and start of puberty. Frequent checks and constant adjustments are warranted the first 2 years.
Do you think it’s only because of honeymoon, or also because of the very tiring and daily routine diet, which is not so appealing to children and adolescents after the first period?
Honestly, diet isn’t an issue. She eats the same (generally healthy) diet as the rest of us, just with the added challenge of administering insulin.
For her, it’s 100% honeymoon and hormones playing havoc with her body’s needs, together with all the other variables, of course.
Not discounting the role of mental health. It’s a huge issue for every human being, and certainly people with a chronic condition to manage face extra challenges. But speaking only for us, that hasn’t been a factor yet, thank goodness. (She was also diagnosed in those golden years when kids still want to please their parents. Plenty of people have warned me about what likely lies ahead!)
But a restricted diet for her to tire of or rebel against? No, we haven’t had that.
Hello doctor. I’m sure you agree education is the greatest tool, and patients do appreciate it when their doctor is willing to go beyond the textbooks and med school classes to learn from their real life experience. Since this is your first time treating a patient with diabetes I thought you might like some reference materials to expand your knowledge. This won’t take the place of formal education but might help you increase your understanding a bit.
The first - professional.diabetes.org - Journals | American Diabetes Association - is for professionals.
The American Diabetes Association is a nonprofit that seeks to educate the public about diabetes and to help find a cure:
https://www.diabetes.org
The author of the book Think Like a Pancreas has diabetes and works in the field, I believe as a nutritionist: Think Like A Pancreas, 3rd Edition | Integrated Diabetes Services
I used to have a subscription to Diabetes Health - it had articles and information I found helpful as a person living with diabetes, including occasional comparisons of different devices:
https://www.diabeteshealth.com
You might find these helpful as you learn to understand what life is like for your new patient, and educational to some degree; but I hope you have the opportunity to get formal training as well. Some of the above may have info on both Type1 and Type2 so he sure you are looking at the right one.
I was diagnosed almost 1 year ago and 10 months later I still haven’t hit my target A1C two days ago I found out it’s currently at 8. Hope this helps!
If your son is on a pump, there is no need for any special diet.
We definitely made sure any fast-acting carbs were accompanied by protein and/or fat to slow things down.
Timing of insulin can help with postprandial issues. For kids, there is some insulin resistance in the morning, or there was for my kid, so for that meal we did do insulin 3-10 minute before eating, depending on blood sugar. Also my kid never ate with a blood sugar over 140.
You do have to be careful with a kid who won’t eat what was planned but in a situation where that seems dangerous, there is always juice or glucose tabs. Better to be high then tank low!
The question assumes too many things that I believe are fundamentally wrong.
First, that your being a doctor equips you provide proper care of a child with diabetes. It does not. Your asking strangers in an internet forum instead of professional colleagues is proof of that.
You need to take the child to an endocrinology practice group that treats children. A GP with outdated knowledge is as likely to harm a child with diabetes as help them.
Second that a child is an object to be compared to other children. That should end with the health exam. Going to beyond that is statistics not medicine .
Third, you don’t understand the A1C test. The HbA1C metric is a metric that’s not not really useful for anything except diagnosis. A person could be hypo half the time and hyper the other and have an A1C under 7. You can’t tell from an A1C result, what if anything, needs to be changed.
Fourth, what you think of as targets are benchmarks that a doctor wants reached. More often than not those are set to make the doctor look good, or the patient “non compliant”.
If those were universal and achievable, everyone would reach them without doctors. They aren’t.
Achieving control of diabetes is a learning experience. It requires not desperation but dedication and education. The “target” isn’t a test score, it’s living to adulthood and independence without trauma or being being subjugated by a disease.
If you set an arbitrary goal that is too far removed from where a person starts, then you set them up for failure and discouragement. Setting a metric for a child that the child cannot hope to achieve on his own defies reason. It’s the family that needs to learn -n s if they ALL had diabetes- and the child will learn what it is able as it i bke.
The first “target” for the family of a child’s with diabetes is seeing the right kinds of doctors at the right times.
When a Mercedes EQS sedan breaks down, you don’t try to fix yourself, then take it to a diesel tractor repair mechanic or ask your neighbor what to do. You take it to a Mercedes dealer who has the newest tools to work on that model, and they will turn to specialist if they can’t fix it.
Meaningful behavior that can be checked are things like like checking blood sugars before every meal, giving medications on a schedule, sending those logs to the doctor weekly, making sure that dedicated carbs are always available with the child along with instructions how to use them, planning meal, and recording everything. Meeting with an affinity group and a diabetes educator should be done concurrently. Childhood type 1 diabetes is too complex and too fragile to learn without direct human support. (I had a tough time doing it when I was 30 years old. )
If these become habits the child will be cared for properly. Its health will improve. That’s the immediate target