The A1C is a 3 month average of what the blood sugar has been running. Sara’s A1C has bounced back and forth over the years. When it has been higher, we focused on these tips. There will be seasons or times when your child’s A1C is higher, and that’s normal. Don’t get down on yourself, just focus on ways to improve it. High A1C’s can be a result of hormones in puberty or growth spurts. It’s all part of living with type 1 diabetes.
Ways to lower A1C:
Check blood sugar at least 4-6 x day and bolus all blood sugar corrections and all carbs, including snacks.
- That’s an obvious one, but one that gets slacked on frequently. The more blood sugar checks and corrections you have, the less amount of time spent high so the A1C is lower.
- The goal would be to have to do less corrections because the settings are correct and the carbs are always entered for meals (see below).
- Many of the pumps have a missed meal bolus reminder. When Sara’s blood sugar is high, frequently it is due to a missed bolus. The toughest times are after school when she snacks. Now that’s she’s older, I don’t watch everything she eats and she is responsible for bolusing.
- A missed meal bolus is a time span entered into the pump settings, and if no bolus is given during that time, an alert will sound.
- For example, Sara had a missed meal bolus from 3-5 pm. If she ate after school and didn’t bolus, at 5pm her pump would beep. If she had eaten, she could add the carbs to her pump for a late bolus. If she hadn’t eaten, she just cleared the alarm. For a while, we had them set from 3-4pm, and 4-5pm to give her more alarms. Figure out what would work for you.
- In kids, frequently a bolus is given after the meal due to fluctuating appetites and not knowing for sure what your child will eat.
- When the bolus is given before or at the beginning of a meal, the spike with a meal is less. To accomplish this with a small child, you could bolus for half the carbs at the begining of a meal, then bolus the extra carbs at the end of the meal. That way, some insulin is in the system starting to work and lessening the spike.
- Example: if Sara had 60 grams of carbs on her plate, she could bolus for 30 grams to assume she would eat at least half of the meal. After the meal, she would figure out how much she actually ate and subtract the 30 grams already dosed for and bolus for the rest.
Test Basal Rates:
- Here’s a post on basal rates and testing.
- If your blood sugar is high overall, or high overnight, test your basals and determine if the basal needs to be higher at certain times of the day. If the basals and bolus settings are correct, you shouldn’t have to give frequent correction doses.
Test Bolus Settings:
- Here’s a post on bolus settings.
- Monitor the blood sugars after a meal and after a correction. If they are high or low on a consistent pattern, then the settings may need to be adjusted.
- Basal and bolus settings have to be changed somewhat frequently in children and adolescents due to growth and puberty so that’s normal. That’s why I try and educate parents to learn how to adjust the settings correctly because a lot can change in the 3 months between physician appointments.
- Always look for patterns, don’t adjust settings based on one episode!
Count carbs accurately.
- Here’s a post on carb counting.
- If you aren’t putting the correct carb amounts in the pump, the blood sugar will be off.
- Oversee what your child is entering if they are beginning to do this on their own.
Wear a Continuous Glucose Monitor (CGM).
- If your insurance will cover and you can afford a CGM, try to have your child wear it consistently.
- A CGM monitors the blood sugar and gives you a reading every 5 minutes. If helps catch the lows and highs earlier, which helps with A1C. It can give a parent a great sense of security, knowing they be alerted for a low blood sugar.
- CGM also helps tremendously with getting your pump settings correct.
Download your child’s pump and CGM frequently.
- When I download Sara’s pump weekly and looked at the patterns, her A1C is better. Somehow seeing those patterns of when she is high during the day helps me pay more attention.
- All the pumps can be downloaded. Go to the pump website for instructions on downloading the pump if you don’t know how. It’s awesome for seeing an overall picture of what is going on.
Use Temp Basals for high days.
- A temp basal is a setting on the pump where you can increase the amount of the basal for a set time of day. See your pump owner’s manual for instructions on how to set.
- If Sara is having a day where she is running high, maybe due to stress or hormones, we can set the basal for 10% higher for 8 hours or so. This helps to lower the overall readings. Same for if she has a day where she is more active, we can set it 10-20% lower to avoid lows.
Hope these tips will help you get better control with a pump. Work on a few and see if they help. Be sure to let me know if these help and what other things you do to help with lowering your child’s A1C in the comments below! Be sure to discuss any changes with your doctor or provider before making any changes to your child’s treatment regimen.
If you are interested in further reading on living with an insulin pump I highly recommend the book Pumping Insulin. It tells you all about pumps, special circumstances, and finding patterns and how to adjust settings. (this is an amazon affiliate link. You will not pay more for the product, but I get a small referral fee to help support this blog.)