Q: I feel like getting our son’s A1C results is like getting my report card as a parent. How can I use this information without feeling judged?
A: At its most basic, the hemoglobin A1C test is a measure of average blood sugar numbers over the previous three months. Yes, doctors do use A1C as a valuable tool in determining your child’s diabetes management. But we also know that A1C, especially in children, can never tell the whole story of what has actually gone on over the past three months.
It could be that a child had a really rocky first month, due to a cold, growth spurt, or some other reason, followed by two really stable months. A child’s A1C might still be off because of this, even though the majority of the time blood sugars were within range.
Children are constantly growing and changing, especially during puberty, and it’s normal that these different phases can cause blood sugar to fluctuate. It’s unrealistic to think that children will have “perfect” blood sugar management -- and perfect A1C levels -- all of the time. What is expected, however, is that parents (and children old enough to self-manage certain tasks) will learn how to adapt and respond to these fluctuations. Depending on the underlying cause of out-of-range blood sugar trends, correcting one might take a day, a week, or a few weeks to accomplish.
This is why bringing in your child’s day-to-day blood sugar logbook is so important -- to paint the fullest picture possible of the last three months. If the A1C is not within its expected range, we can look back to see what challenges your child may have faced and what we can do to accommodate for them the next time these same issues come up.
Of course, A1C can show out-of-range numbers that do indicate a need to dig deeper and work more closely with parents and children to get things back on the right track. However, for most parents, feeling nervous or judged when it’s time to talk about A1C is really just a case of being too hard on yourself.
A1C testing is a way to help you, your doctor, and your entire diabetes team take good care of your child. You collect information about your child’s diabetes -- in the form of blood sugar checks -- multiple times a day. Within the larger framework of children’s growth and development, try thinking about it this way: A1C is simply more information.
--Naznin M. Dixit, M.D., is professor and chief of pediatric endocrinology and diabetes at the University of Mississippi Medical Center and Batson Children's Hospital in Jackson, Miss.
How Other Parents Deal
“At every appointment, I always bring along our blood sugar log and the diary that I keep noting sick days, trips, soccer practice, and other events that might affect my son’s numbers. It helps give the A1C some context. One month, his A1C was high, but it was also cold and flu season, and he’d had at least two viruses. This led to a helpful conversation about sick day care, with absolutely zero judgment on the part of our endocrinologist.”
--Tamara W., mom of 6-year-old Andrew
Disclaimer: The information in these articles is not intended as medical advice. Families should check with their healthcare professionals regarding individual care.
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