Category: HbA1c

Are children not getting the recommended diabetes checks?

imageWhen I was a child, I remember having several check-ups every time I’d attend my diabetes appointments. After my diagnosis my check-ups were every 3 months and then it became every 6 months. These checks covered everything from, cholesterol testing, blood tests, feet check-up. Both of these tests would also be checked at my GP surgery once a year.  My eyes were tested at my opticians, annually.

Nevertheless all the results from these check-ups would then be sent over to my consultant at my diabetes clinic. Every appointment the doctor would have the most recent results from these check-ups. Appointments moved swiftly and results were explained in as much or as little detail needed. Any concerns or advice were given and time for listening was also given. Everything was in order and none of my check-up were ever missed.

However, a recent study of children ages 12 to 24 with diabetes, attending paediatric diabetes units in England and Wales proposed that, nearly 75 % of these children are not getting the necessary health checks.

70 % of these children are in fact type 1 diabetics, who are insulin dependent and require these check-ups to be carried out at least annually, routinely and efficiently.

From the study, data was collected from 27, 682 children and young people, which outlined that only 25.4 % of these children (ages 12 to 24) were having the seven recommended annual checks.

 “Guideline from NICE (The National Institute For Health and Care Excellence) state all children with diabetes should have their blood sugar levels checked every year and those over the age of 12 should also have six other health checks.”

These checks for this age group should include:

  • Measurement of growth
  • Blood pressure
  • Thorough eye tests, examining the backs of the eyes in detail
  • Cholesterol testing
  • HbA1C
  • Feet check-ups
  • Kidney function

The study also found that, from this age group (children age 12 to 24 years old), those who were considered to have “excellent diabetes control” of 7.5mmol/l, had in fact risen to 15.8mmol/l in 2012 and then by 2014 -15 this had risen even further to 23.5%.

These results are extremely disturbing and it clearly shows that there is a failure within the basic support and care of children and young people living with diabetes. These check-ups should be routine and frequent enough so that both the patient and the doctor are aware of the patients diabetes management.

As alarming as these results are, the report carried out also showed that at least 98.7% of these children in this age group had their HbA1c tested. However, only 23 % had started to increase their chances of not developing complications due to poorly managed diabetes.

On the other hand, the most frequently missed checks amongst children age 12-24, involved foot examination, eye screening and cholesterol testing.  All these tests are crucial when it comes to managing diabetes treatment and the regularity of these tests being done will only aid in the detection of any signs of diabetes complications or any damage being done to organs. Detecting signs for complications such as (blindness and kidney damage) early could potentially help to avoid or lessen the effects of the complication and if treatment is necessary then it can be administered at an early stage.

The study also showed that children from poorer areas were found to have worst HbA1c test results whilst children in more prosperous areas were found to have better HbA1c results.

Bridget Turner, director of policy and care improvement at Diabetes UK, said, “There remains considerable variation in the level of care provided. This is very worrying because if children and young people are not supported to manage their diabetes well in early life, they are more likely to be at risk of debilitating and life threatening complications in adult life such as amputations, blindness and stroke.”

Since the report, The NHS (National Health Service) are working to improve the delivery of effective integrated diabetes services with the help of clinical commissioning groups across Wales and England.

I hope that future reports will show that children within this age group suffering with diabetes are being taken care of and not going without these fundamental check-ups, regardless of their economical status.

Amina xx

HbA1c!!!

HbA1c WHAT'S YOURS

HbA1C! When I first became diabetic I had no idea what this even meant. I just knew that every 3 to 6 months I would have blood taken from my arm. This blood sample, which seemed like gallons of blood, would then come back to me, a few weeks later in a percentage format. The doctors and my parents seemed happy and that made me happy. “I felt a sense of achievement.”

Let’s start with a few basics!

The blood stream is made up of red blood cells these red blood cells contain haemoglobin or Hb. Red cells can live for 8 – 12 weeks before they are replaced. Hb carries oxygen in the blood from the lungs and then to the rest of the body.

“So what did it all mean?”

As I developed a better concept of science and my diabetes, I began to understand, that this HbA1c was an average measurement used to identify the level of control I had maintained over a prolonged period of time.

HbA1c occurs when haemoglobin binds (Hb) with glucose in the blood stream. The glucose and the haemoglobin molecule form a glycated haemoglobin molecule.  This is known as A1c or HbA1c.

 

Hb + Glucose = HbA1c

 

Someone without diabetes produces normal levels of glucose and therefore produces a normal level of glycated haemoglobin (HbA1c). The more glucose in the blood stream, the more haemoglobin A1c or HbA1c in the blood. Higher levels of glycated haemoglobin in diabetics would suggest poor blood glucose level control.

These high levels of HbA1c are associated with diabetic complications such as retinopathy (eye complications)  and neuropathy (nerve damage). There are many other complications, which I will touch on in my next post. HbA1c levels do not ensure that complications will develop or will not develop. However it has been proven, that having good control and a good HbA1c will reduce the chances of these complications arising.

What should your HbA1c be??

  HbA1c in mmol/mol (new unit) % HbA1c (old unit)
Non diabetic  30 mmol/mol 4.90%
Diabetic 48 mmol/mol 6.50%
Diabetic prone to hypoglycaemia 58 mmol/mol 7.50%

HbA1c testing in diabetics depends on the individual and how well they control their blood glucose levels.  A diabetic prone to hypos, but is trying their best to achieve tighter control on their diabetes, HbA1c test is carried out every 3 months.Once the individual is able to control and retain good control, HbA1c testing should then be carried out every 6 months. Since I had my son, I’ve suffered a great deal with low blood glucose levels. Currently I have my HbA1c tested every 3 months, due to my nocturnal hypoglycaemia. This is something I’m working hard to get rid of and maintain a good level of control, as I always have.

 

My current HbA1c = 7.4%  57mmol/mol

My dream HbA1c = 5.0%   31mmol/mol

Pregnancy HbA1c = 6.4%  46mmol/mol

Print

 

Amina xx

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If you have bad control, or perhaps your HbA1c wasn’t so great the last time.Its not the end of the world. Stay positive and please don’t give up. Keep on striving for a better HbA1c. Use your diabetes team and get them to help you. However you must help yourself first by, taking regular notes of your sugars and create a picture of what is happening with them. The only way to make changes and achieve a good HbA1c is to take the steps to control your blood glucose levels.