The most recent trial of 2008 was our 16 year-old daughter, H's, diagnosis of Type 1 diabetes that we received October 1st. Without any family history of diabetes, the thought of the disease was not even on our mental landscape, so it truly was a surprise in every way. When our daughter was admitted to the hospital 3 months ago, her blood glucose was 492. For perspective, non-diabetics have a blood glucose range from 70-120. The 3 day hospital stay was necessary for medical intervention to rehydrate H's body, get her blood sugar levels into a safe, healthy place, receive diabetes education and instruction, and conduct many other physical evaluations and blood tests. Among the blood tests conducted was the "HbA1c" or the "A1c" . We didn't know what it meant at the time, but were told that H's A1C was 17. 'Okay...is that good, bad or ugly?' Didn't know until a few day later what that meant.
According to our diabetes bible*, the A1C test: "Can be thought of as the "forest" and the blood sugars as the "trees"." The A1c test, "tells how often the sugars have been high for every second of the day for the past 90 days; [the test] should be done every three months; [and] should be in the desired range for a person to be in 'good sugar control'." As it was explained to us, the test measures how many sugar molecules have attached themselves to the red blood cells. The longevity of a red blood cell is about 90-100 days, so doing the test every 3 months gives a pretty good indication of how saturated the red blood cells are with glucose (sugar) over the cell lifespan, and will indicate if good blood sugar control is happening. It is important to have good sugar control because not only does a person feel better, but it also "lessens the risk for eye, kidney, nerve and heart problems from diabetes", which of course is our long-term concern for H. The "17" of H's A1c in the hospital meant that her red blood cells were 17% saturated with glucose for at least 3 months. A non-diabetic has a number ranging from 4.3-6.2%! Quite a difference there. For diabetic teens, the goal is 6.5 to 7 on an A1c scale.
We have already learned so much about this disease and have had to correct many wrong notions we had prior to being a family with diabetes. When H was first diagnosed, we immediately all thought, 'oh, this means she can't eat sugar'. Well, actually, she can eat sugar and any other carbohydrate--which all break down to sugar in the blood stream--she just has to give herself insulin for every carbohydrate gram she eats since her body in not producing the insulin that converts these sugars into energy. So this holiday season and all the special treats that come with it, was not a season of deprivation, but one of figuring out total carb amounts for favorite family recipes and treats, breaking these down to 'serving sizes' and carbs per serving, taking insulin accordingly and enjoying all the delicious special tastes of Christmas (and Thanksgiving). Did you know that a full batch of fudge has 1104 carbs and that Chex Muddy Buddies have a whopping 1230 carbs per batch? And I have to sing H's praises. She has been such a responsible young woman in managing her diabetes. Sure she has the days of being angry that she has to do this the rest of her life, or frustrated that she can't just snack like most young people her age, or tired of having to plan every event, every detail of going to a friend's house or even to the mall; but she has continued to be very diligent in her monitoring and injecting of insulin.
Sorry to go all educational on you. I'll save further diabetes fun-facts-to-know-and-tell for subsequent blogs. Back to the A1C test...
Yesterday was the 3 month check up with H's endocrinologist. We have seen the doctor several times since October, but yesterday was the official 3 month mark since H's diagnosis, and so it was the first visit when an A1c would be conducted since the hospital test. Oh, let me digress just a little bit here (I know...like I haven't already digressed a few gazillion times...) I have to comment on the technology of all of this. At each visit H. takes her blood glucose monitor with her and gives it to the assistant at the office. Information from the blood glucose monitor is then downloaded into a computer program at the doctor's office that prints out the hourly/daily readings on a grid by time of day, daily, weekly and monthly and then gives an average of the readings for each time period of the day! Isn't that the coolest thing! Okay--back to yesterday's appointment.
Dr. L looked over H's print out of her "numbers" since the last appointment and said that she could tell that H. had been doing a great job in managing her "levels". (For someone H's age with diabetes, her 'good sugar control' target range is 80-150 at any given time of the day.) It was then time for 'the test' and Dr. L took H. into the other room to do the A1c. A small blood sample from a finger poke is put on a special test paper and then into the computer-scanner-thingy it goes. After about 6 minutes, the results are in.
H's A1c was a beautiful 6.5!
Woohoo! We were all so excited. I can't tell you how reassuring it was! I'm so aware of health complications that can arise from diabetes, and to know, that at least for the first 3 months of this disease, H is on a good road to protecting her health long-term.
It is so true that our perspective has changed over the last year. Four months ago we never gave a thought to diabetes, and now here we are embracing it as a part of "normal" life. It is amazing how we can adjust to things. In fact, that has been one of the biggest lessons that we have encountered repeatedly throughout 2008; every trial or challenging circumstance is an opportunity for the Lord to refine us deeper and for us to grow closer to Him as we experience more of His character. When my reserves have been so low and I have had no strength left to 'do life" in my own power, and the only thing I could do was to cling to Jesus...I've discovered it has been a place of blessing, comfort, peace and abundance in the midst of pain. (The "work" is learning to live consistently dependent on the Lord when times are pretty good and easy going!) Through circumstances of the past year, our entire family has also come to know that the Lord's presence and faithfulness in a way never experienced before. Although we are still grieving many losses--not just that of our mothers and grandmothers--but in many different ways, we are all still alive, still breathing and have been blessed as well. We are thankful to know the Lord more intimately and to feel his strength in us.
As we welcome 2009, we are filled with hope and expectation of what the Lord is doing and will continue to do and, I'll confess, praying that the year ahead will be a little less event-filled than 2008!
* A First Book for Understanding Diabetes by H. Peter Chase, MD
