I'm mid freak-out about dd's health. Please only come in if you're gentle...(long)

[Julie in CA]

ETA: long and emotional, so if you decide to read--Thank you!

{Deep breath...} I need someone to explain to me about blood sugar, Hemo A1C, insulin, and diabetes. I need it exlained as though I'm 5 years old. I just seem unable to wrap my mind around how this works.

 

I'll give you the background (Sorry if it's too much). I am extremely overweight, and every woman in my family has been, regardless of how much working out or dieting happens. This is not an excuse, just an explanation of fact. My sister works out heavily, and eats minimally. Still obese.

 

My dd's are very overweight, even though they're fairly active, and we eat reasonably healthful foods. I'm not excusing it, so please don't come down hard on me. We've been making a very concerted effort to control portion sizes, eat minimal amounts of sugars & starches, and push more & more veggies. Older dd (14yo) has responded well to all of this, and has lost over 30 pounds in the last 6 months. Younger dd (12yo) is just not getting there. She has some other physical symptoms that made me wonder if there were another underlying problem. Dark discolored skin around her neck, slight {gulp} buffalo hump, and pretty extreme weight gain over the past couple of years. Pediatrician ordered fasting tests which showed no thyroid issues, low cholesterol, but increased Hemo A1C (?) Do I have that right? They told me the level should be way under 17, but dd is at 20. I have no idea quite what those numbers mean, but I'm told that's very *very bad*.

 

After the lab results arrived, the doc wanted a follow-up appointment with me and dd to discuss nutrition & fitness. I haven't booked an appointment yet, because I'm pretty sure that it won't be useful. We know the stuff to do, and we're doing our darndest to do it. More guilt for her is *not* the answer, nor, I think, is me watching her every second and forcing control over every action of her body. I understand my responsibility to keep her healthy, but I want her mentally healthy, not just physically healthy. I'm trying to walk that line. We will redouble our efforts. Together. Nicely, without recrimination, and with every bit of effort we both can muster.

 

The nurse made it sound as though she's going to die tomorrow.:ohmy: Since I don't understand the numbers...well, I'm just sick. Are we really out of time? Is there no coming back from this in a healthy way that isn't punitive? I've always been willing to take the hard line with my kids when necessary, but I usually try to do it without crushing them. Please, if your advice is to crush her, don't post. If you have explanation for me about the numbers, or advice on how to help her without crushing her sweet, gentle, lively spirit, *boy do I need that!* :crying:

 

(And lest you notice my sig line, no, we don't eat desserts at our house. Dessert fairy is my *professional designation*, not an indicator of what our family diet consists of.)

 

ETA: I'm crushed already, so you don't have to work at making me "see the seriousness" either.

Edited August 16, 2010 by Julie in CA

[ktgrok]

I'm not familiar with the numbers, but wanted to offer some advice. I also struggle with my weight, since I was young, even eating healthy food. What I've learned lately was to eat a more "paleo" style diet. In other words, whatever meat and fat I want, but the only carbs I eat are fruit, nuts, and sweet potatos, corn on the cob, and squash. No bread, crackers, sugar, cereal, pasta, etc. The occaisonal white potato, but I feel that later. Almost instantly I noticed my appetite decrease and I lost 4lbs in a week, when I hadn't been able to lose one in months. But the big thing was I wasn't hungry or shaky or anything. But eat lots of fats, and use the fruit paired with nuts to satisfy the carb craving. Google paleo diets to get more info.

[amys]

I don't know anything about this (sorry!!) but wanted to give you some encouragement. They will almost certainly send you to a nutritionist, who will help and support you in your efforts to get her blood sugar under control, if that's what the problem is. Apparently, other issues can skew the results of this test:

 

From webmd:

"Patients with diseases affecting hemoglobin such as anemia may get abnormal results with this test. Other abnormalities that can affect the results of the hemoglobin A1c include supplements such as vitamins C and E and high cholesterol levels. Kidney disease and liver disease may also affect the result of the hemoglobin A1c test. "

[Country Mouse]

I wish I had some advice, but I just have hugs (((julie))).

[WeeBeaks]

Hemoglobin A1c is a measure of long(er) term blood sugar, rather than just taking it at one point in time as typical fasting or nonfasting blood sugar levels do. Wikipedia:

http://en.wikipedia.org/wiki/Glycated_hemoglobin

 

A higher than usual level would be indicative of a prediabetes or diabetes condition.

 

Weight, diabetes, blood sugar, insulin, etc., is probably better explained in a book or a search engine. It is fairly complex, and can also involve concurrent conditions such as polycystic ovarian disease, thyroid issues, etc.

 

If you and your DDs are struggling with it, probably a complete physical is in order. I would guess at that followup appointment, they might want to discuss diabetic diet, which is essential to diabetics of course but can help those likely to become diabetic over time. (That is me too by the way with family history and other factors.)

 

baby is waking up but wanted to answer a least briefly.

[bzymom]

I don't have any medical advice, but wanted to offer a :grouphug:. I'm sure this is very difficult for you and your d/d.

 

For what it's worth, perhaps you can meet with the doctor on your own so he can better explain the test results in a clear, concise way and what his recommendations are, and whether a specialist (an endocrinologist?) might be able to better handle your daughter's medical needs in the immediate future.

As this has been very upsetting, try to see yourself as your daughter's advocate in gathering information and making plans to help her, just as you do in homeschooling.

 

I hope you are able to get some answers, and some compassionate care for your daughter so she can be happy & healthy.

[Nakia]

Hgb A1C should be less than 6 or 7. 20 seems so high that I have to wonder if you were given the right information. Does she have symptoms of diabetes ie: frequent hunger, thirst, and excessive urination?

 

BTW: In NC, it is actually outside of a nurse's scope of practice to interpret lab results. We are only allowed to give the lab numbers, if given permission by the physician. You need an appointment with a physician. I am assuming that the nurse is not a nurse practitioner.

Edited August 17, 2010 by Nakia

[JoyfulMama]

The numbers mean that your dd's body is not functioning optimally. In order to improve the way her body processes food, you will look at what she eats/drinks (how much, when), as well as how much she moves (exercise - what kind/how often). Honestly, regular exercise is the BEST treatment. She may benefit from medication to improve the way her body funtions.

 

Will she die tomorrow? Well, probably not. She could get run over by a bus, true. However if her body funtions in this manner over a period of time (not days, here, but months, many months, years, many years) then it will take its toll.

 

Any changes she makes will be beneficial for the entire family to also make. Be open to any kind of education that is offered, even if you think you don't need it. Partner with your dd here - it is ultimately her body, and she must be in control of it, not allow it to control her.

 

:grouphug: You will understand more when you talk to the doctor. I don't want to put words in his mouth. But everything WILL be ok.

[Giraffe]

I agree the H1AC seems really really high (DH runs around 8 and that worries his doctors). I would go in without DD if you're concerned about her reaction and get the information you need. Or call them and find out if they want to run additional tests or what and then decide how to approach. Don't put it off, just gird your loins and get the info you need to address the issue. She may have Type 1 diabetes that's been undiagnosed and needs treatment. (Not a doctor, just throwing out a possibility.)

[Denisemomof4]

I have NO idea what that A1C number is all about, but I come from an obese family and have had blood sugar issues all my life, so I can share from my own experience.

 

My first suggestion would be to find a glycemic index and use it. I read Sugarbusters and used the scale to eat all low glycemic foods. I'm not diabetic, I'm hypoglycemic, but diabetes runs in the family and I believe I'll be diabetic one day.

 

Once I hit my 40's I started to gain weight. I'm certain stress was a HUGE part of it for me. When anyone outside my family spends any length of time with me they are SHOCKED to see what I eat. I don't eat much. But I am sluggish and stopped my walking when I took care of my mother. Due to a recent injury I have to put walking on hold again. I'm about 30 pounds overweight but I still understand obesity not being linked to food intake.

 

What is the A1C?

 

If you eat ALL low glycemic foods and get exercise, I'm certain you'll see more results. BUT, I would do this without making a big deal of it At All. I recently consulted a nutritionist for dd10. The diet was a huge change from what she was used to eating so I did it with her. I didn't make a big deal out of it, and I showed GREAT appreciation for the YUMMY food we were eating. It got hard after awhile, I won't kid you. It's not easy to eat one way and then cook and watch the rest of your family eat another way. But in your situation, this is going to be a lifelong endeavor. Figure out how to make it work for you. You will one way or another.

 

You may be eating healthy, but you may be still eating the wrong foods. Corn and carrots are high on the glycemic scale. The best carbs are quinoa, amaranth and buckwheat. Have more legumes. Do your research.

 

Best of luck

[littlebug42]

Julie,

 

My MIL is diabetic and I know that her docs have always monitored her A1C levels. She had been on diabetes controlling meds for years and when it was no longer controlling her A1C levels appropriately, she was switched to insulin injections last year.

 

I have been reading up on insulin resistance in the body and how it affects some people. One of the symptoms of insulin resistance is the inability to lose weight. I have PCOS and I know my body has problems processing insulin. Do some research into the diets associated with insulin resistance and see if perhaps this might help with some dietary changes. I have been trying to implement some of the ideas here and I think it can be done in a non-crushing way. I have a book called The Insulin Resistance Diet by Cheryle Hart, MD and Mary Kay Grossman, MD that is a good place to start.

[DianeW88]

Um, that number for an A1C is off the charts. Are you sure it's the right number?

 

As far as what the test is, it is a measurement of your blood sugar over a two to three month period, not just a "right at this moment" look. It is looking at what percentage of your hemoglobin is coated with sugar, basically. So, the higher your A1C number, the poorer your blood sugar control is. In a person WITHOUT diabetes, the A1C is usually somewhere between 4.5 to 6. For someone with very poorly controlled diabetes, the number is usually above 9. But a 17 would corollate to a blood sugar number of over 300mg/dl. I'm assuming you have an appointment with a physician tomorrow??? Because if not, I would get one.

 

Diane W.

married for 22 years

homeschooling 3 kiddos for 16 years

[AngieW in Texas]

Has your dd been tested for Cushing's syndrome? That was the very first thing I thought of when I saw your post.

 

http://endocrine.niddk.nih.gov/pubs/cushings/cushings.htm

http://www.doctorslounge.com/endocrinology/diseases/cushing.htm

http://endocrine-system.emedtv.com/cushing%27s-disease/symptoms-of-cushing%27s-disease.html

 

edited to add:

You may want to check into PCOS as well.

http://www.medicinenet.com/polycystic_ovary/article.htm

Edited August 17, 2010 by AngieW in Texas

[Denisemomof4]

ok, I just read the responses made while I was typing my post, and I now know what the A1C is. A high reading on this test IS very alarming, because it measures the sugars over a period of time.

 

I'd definitely go with a low glycemic diet and exercise. The diet will be hard at first but she will feel SO MUCH BETTER. I've changed the way I eat a few times and you learn to appreciate your new diet and find new favorites.

 

I know you know this is nothing to mess around with. I would really stick to a strict low glycemic diet.

[amys]

I wanted to add that it sounds like you are assuming this is a result of her being overweight, and are reluctant to follow-up with the doctors because you don't want to make her sensitive about her weight. I wanted to point out that even if it is diabetes, it's possible that she could have Type I diabetes rather than Type II. My brother developed Type I diabetes as a young adult, apparently as a result of a viral infection. Untreated diabetes can have terrible effects on the body, which I humbly suggest can be way more devastating than being told by a doctor that you need to lose weight. :grouphug:

Amy (who needs to lose a boatload of weight herself, with one kid who is at risk of following in my footsteps & got the lecture from the ped at his last checkup)

[KayT]

:grouphug: Sorry for your struggles. Dh just got his level under 7. I missed if she was given any meds for this or not, but that can help. I found the below article helpful when dh kept talking about this test. 20 seems really high, I think a talk with the doctor is order would schedule asap! :grouphug:

Sorry the chart didn't copy over...will have to follow link to see it!

 

http://www.medicinenet.com/hemoglobin_a1c_test/article.htm

 

 

What is a hemoglobin A1c (A1c)?

 

 

To explain what an A1c is, think in simple terms. Sugar sticks, and when it's around for a long time, it's harder to get it off. In the body, sugar sticks too, particularly to proteins. The red blood cells that circulate in the body live for about three months before they die. When sugar sticks to these cells, it gives us an idea of how much sugar has been around for the preceding three months. In most labs, the normal range is 4-5.9 %. In poorly controlled diabetes, its 8.0% or above, and in well controlled patients it's less than 7.0%. The benefits of measuring A1c is that is gives a more reasonable view of what's happening over the course of time (3 months), and the value does not bounce as much as finger stick blood sugar measurements.

There is a correlation between A1c levels and average blood sugar levels as follows: CHART SHOULD BE HERE!

 

While there are no guidelines to use A1c as a screening tool, it gives a physician a good idea that someone is diabetic if the value is elevated. Right now, it is used as a standard tool to determine blood sugar control in patients known to have diabetes.

 

A1c(%)Mean blood sugar (mg/dl)6135717082059240102751131012345

The American Diabetes Association currently recommends an A1c goal of less than 7.0%, while other groups such as the American Association of Clinical Endocrinologists recommend a goal of less than 6.5%. Of interest, studies have shown that there is a 10% decrease in relative risk for every 1% eduction in A1c. So, if a patients starts off with an A1c of 10.7 and drops to 8.2, though there are not yet at goal, they have managed to decrease their risk of microvascular complications by about 20%. The closer to normal the A1c, the lower the absolute risk for microvascular complications.

[Ester Maria]

HbA1c is a glycated hemoglobin. I'll translate that to normal English, but I don't have my husband next to me to explain things nicely and professionally.

 

So, if you were a five year old, hemoglobin is the part of your blood, actually of your red blood cells - it's a substance that's found within them that's a "transport machine" of oxygen in your body. That's its key role and it's very important. Following me?

What does "glycated" mean? It relates to sugar - you've probably heard of glucose, so glycated means something that the sugar has affected.

To put in very simple terms, when your sugar levels are too high, they "build up" (imagine it visually) in your blood and combine with your hemoglobin. That way, hemoglobin becomes very "glycated". One of the method of measuring sugar in your blood and how dangerous it is is by measuring, thus, glycated hemoglobin. Now, why is it important, even more important than "normal" test?

 

Because it measures long term effects. The results you get by pulling out HbA1c do not reflect how much chocolate you ate two minutes ago - it's more like, they reflect how much chocolate you ate in the past few weeks, not to say months. (I don't know very precisely about this one, but you get the bottomline: LONG TERM sugar effects on your blood.)

 

If your daughter is at 20%, I won't lie to you, that's PRETTY bad, I was shocked when reading that part. Now, my shock might mean they use some scale that I'm not aware of (it's unlikely though, especially if they panicked, as I believe it's measured in regular percentage and thus not scale-dependent), but normally, it should be 4-6%, something like that, since I know that to diabetics they recommend to keep it below 7%.

 

Is it going to be possible to get her heatlhy without any dramatic changes in her lifestyle? If I'm reading all what you wrote correctly, highly unlikely, and I believe it's the reality you need to accept NOW. I fully realize all you write about not wishing to crash the spirits of the young girl, but the time of "compromises" might have as well have run out - and now you've only got to be informed of it. Personally, I wouldn't play with the fire in this case. I'd go to meet the professionals and implement everything they advise. I would also cut - not reduce, cut - fructose out of her diet urgently (other than natural fructose that occurs in fruits), both from refined sugars and from the rest of the processed foods where they make up with fructose for the lack of fat and to affect the taste of the food. She's no longer at the point of being able to eat "minimal amounts", whatever it means - she needs to make some drastic changes. You are no longer in a position to choose the preferred method if her health is at stake - and if I'm reading your post correctly, it certainly is.

 

I'm sorry. I know how hard it must be for you, and I know you didn't want this type of answer, but I seriously suggest you not to take this lightly. Go to the doctor soon and be ready for some drastic changes.

:grouphug::grouphug::grouphug:

[Hockey Mom]

:grouphug:

 

NM. Follow Ester Maria's advice.

 

My thoughts and prayers are with you.

Edited August 17, 2010 by Hockey Mom

[Snickerdoodle]

First, ask the doctor to explain the results to you. You will get more reliable information this way.

 

Second, I found this book to be extremely helpful:

 

Diabetes Solution

[Mama Geek]

I am sorry to hear about your dd. It is never easy when a child is sick.

 

Do a little bit of research on the low glycemix index. They tested lots of food and how it raises your blood sugar levels. My dh and I have both been successful on this diet which sounds like would have to be a lifestyle for your daughter.

 

We ate nothing but low GI foods in our diet which basically included meat, veggies, eggs, cheese, some low sugar fruits such as berries, and complex carbs (i.e. sweet potatoes, whole grain bread, brown rice). The complex carbs take longer to metabolize. Also one thing that we found while researching is that things like a regular potato if it is raw is low gi and the gi goes up the more it is cooked. We didn't eliminate carbs but we did only eat a serving per meal and then only the low gi carbs.

 

The one sweet thing we are able to eat is peanut M&M's.

[Julie in CA]

Um, that number for an A1C is off the charts. Are you sure it's the right number?

 

No, I'm not sure. They are sending me a copy of the results so that I can read & research a bit.

[Tea 4 Three]

As soon as I read your post, PCOS and insulin resistance came to my mind as well. You might look into a diet called Ideal Protein. It is a bit expensive, but very worth it. My body has responded very well (the only diet that has ever worked for me.) I have learned that my body cannot tolerate hardly any carbs. A diabetic diet is even too much for me. And I know many who have had extremely positive results...even several severe diabetics who were able to get off all of their meds. It is created to address Metabolic X Syndrome.

I hope you find some answers somewhere along your journey soon.

[Audrey]

You want to talk to Jenny in Atl. She has a daughter with diabetes (since babyhood) and is the most gentle, patient, lovely person. She's been dealing with it for a long time, and is very well-informed. I'm sure she'll have much to offer.

 

I'm going to nudge her in this thread's direction.

 

:grouphug:

[kalanamak]

E Younger dd (12yo) is just not getting there. She has some other physical symptoms that made me wonder if there were another underlying problem. Dark discolored skin around her neck, slight {gulp} buffalo hump, and pretty extreme weight gain over the past couple of years. Pediatrician ordered fasting tests which showed no thyroid issues, low cholesterol, but increased Hemo A1C (?) Do I have that right? They told me the level should be way under 17, but dd is at 20.

 

I have never heard of normal "under 17". More like "under 7", which makes the 20 silly. I've never seen one over 12 and they would have called you in immediately.

You either have a different scale down there, or there is a miscommunication.

 

A1C....red blood cells live 120 days. During their trip through the blood, sugar molecules known as glycogen "stick" to them. Everyone has sugar in their blood, or they'd be dead. The higher the sugar level is, the more sticks. So, an A1C is an AVERage sugar level of every second of every day for 120 days.

 

The doctor's scale should give an "average" sugar scale as well as the A1C. You could ask what it is. Also, when they check cholesterol, they should check triglycerides, as people with elevated sugars could have that as well.

 

They should consider Cushings. I don't see kids, so I don't know the youngest age possible for polycystic ovaries. You could google that for symptoms. Is she hairy? Acne? Etc.

 

No she is not dying, but I suspect that THEY suspect pre-diabetes. A1C can replace the 2 hour glucose tolerance test now, but you might want to borrow a glucometer and check a few fasting and non-fasting sugars. Or make an appointment to talk to the doc more. Can you get a copy of the labs and report them to us (you can PM me) more accurately??

 

:grouphug:

[abbeyej]

(((Julie)))

 

My very first advice? Call first thing in the morning and make an appointment with the Ped ASAP. But just *YOU*. Write down all of your questions and concerns -- including *exactly* what you said here about your concerns for her psychological as well as physical well-being. Go in and ask *all* of your questions. About exactly what the numbers mean right now, about what they will mean for the future, about what you should be doing, about whether you should go to a specialist *now*...

 

But go without your dd. Find out everything you can.

 

And then, once *you're* satisfied that you know what's going on and that you and the ped are on the same page with regard to the way you want to approach your dd, *then* bring her in for an appointment.

[dansamy]

An A1C of 20 would correlate to an average blood sugar of 500+. This is "Let's go to the ICU for an insulin drip" bad. So, I'm pretty sure the number is different or is a different scale. I'd make (and keep) that follow-up appointment. This is life-threateningly serious. The harsh reality is that a poorly controlled diabetic will live a much shorter life-span fraught with a myriad of problems caused by rampant blood glucose. Neuropathy, blindness, renal failure, dialysis, amputations.

 

In agreement with Ester above, she is no longer at a place in her health where she can eat processed foods and "minimally". Everything must be measured carefully. Buy a good diet scale. It's a lot easier to do this now while she is young than it is to try and retrain her when she's older.

Edited August 17, 2010 by dansamy

[Twigs]

First, :grouphug: for you and your family.

I, too, have obesity and diabetes in my family.

I strongly suggest that you begin to educate yourself and become an expert on diabetes and the role of nutrition and fitness. Search the internet. Read books. Go to the doctor and learn what s/he has to say. Make sure the doctor investigates any underlying issues. Many in the traditional medical community will advise medications and a low-fat, high-carb diet (ie - USDA food pyramid). This is where your own research comes in. It is possible (maybe not all cases) to reverse Type 2 diabetes without medications and with diet and exercise. Be brutally honest with yourself. Are you really doing as much as you can be? (This is not a question that you need to respond to me about.)

Do you think it would help your daughter to also become an expert, talk to the doctor or nutritionist by herself to take on more responsibility for her own health? Have you (and she) learned about the long term complications of on going high blood sugar? Eye problems, nerve problems, kidney problems … These problems may not show up for YEARS, so it is hard to see how important it is to control blood sugar today, but those problems are real.

I've been eating low-carb and exercising for over a year. My weight, blood sugar, blood pressure are down and my foor cravings are under control for the 1st time in my life. Educating myself has been a signficant factor in my success.

:grouphug:

[Caitilin]

First, :grouphug: for you and your family.

I, too, have obesity and diabetes in my family.

I strongly suggest that you begin to educate yourself and become an expert on diabetes and the role of nutrition and fitness. Search the internet. Read books. Go to the doctor and learn what s/he has to say. Make sure the doctor investigates any underlying issues. Many in the traditional medical community will advise medications and a low-fat, high-carb diet (ie - USDA food pyramid). This is where your own research comes in. It is possible (maybe not all cases) to reverse Type 2 diabetes without medications and with diet and exercise. Be brutally honest with yourself. Are you really doing as much as you can be? (This is not a question that you need to respond to me about.)

Do you think it would help your daughter to also become an expert, talk to the doctor or nutritionist by herself to take on more responsibility for her own health? Have you (and she) learned about the long term complications of on going high blood sugar? Eye problems, nerve problems, kidney problems … These problems may not show up for YEARS, so it is hard to see how important it is to control blood sugar today, but those problems are real.

I've been eating low-carb and exercising for over a year. My weight, blood sugar, blood pressure are down and my foor cravings are under control for the 1st time in my life. Educating myself has been a signficant factor in my success.

:grouphug:

 

 

:grouphug:To you and DD. Then, as PP says above, DO YOUR RESEARCH. Hope that you can figure out a good solution. :grouphug:

[justamouse]

:grouphug:

 

You can do this. Be strong, be there for your daughter and get this done.

 

I don't know how it works in your state, but at your appointment I would ask for a referral to a registered dietitian. In some states Drs and nurses aren't allowed to give dietary advise as it's a different discipline, but in some states they are allowed. Regardless, get the referral.

[Julie in CA]

I value each and every one of them. They've all been very kind too, and I'm very very thankful for that too.

 

It's entirely possible that I've confused the numbers. The labs were done as a precursor to seeing a pediatric endocrinologist. Dd had a physical last week, and the PA was willing to do the referral, and ordered the tests that she knew would be required. It seems that when the regular ped. saw the results, his interpretation is that she doesn't need to see the ped. endo., but needs more strenuous diet/exercise. He's a good doctor, imo, but old-school, if you know what I mean. If the thyroid results look fine to him, that will be the end of that. I'm pretty sure he doesn't mean to do the referral now. I specifically asked the nurse if diet/exercise would be the main subject of the follow-up appt, and she said that it was. In that case, I just wasn't sure it would be helpful. I know about avoiding carbs. She's getting at least 30 minutes of aerobic exercise regularly, almost daily, in addition to normal kid activity in the pool and an informal aqua aerobics class with her ds.

 

We've been trying to eat mostly meat, eggs, cheese, and vegetables.

Limited whole grains, limited fruit.

Very limited potatoes, rice, bread.

No cereal. Almost no treats.

 

I can't say we've been completely successful, but this is how we've been trying to eat for roughly a year. I know that dd has an occasional soda (perhaps 2 per month), and has dessert once per week at church on Sunday nights. We will try harder.

 

I've called the dr's answering service, and left a message that I'd like to make an appointment.

[LauraGB]

:grouphug: to you and your dd, Julie. I would gently suggest to consider things other than diabetes, provided the testing was accurate. That number is way too high, which suggests to me that either the test was botched or misread, or there is a condition other than diabetes at work here.

 

And I agree with Ester Maria:

 

{edited}...but normally, it should be 4-6%, something like that, since I know that to diabetics they recommend to keep it below 7%.

 

Is it going to be possible to get her heatlhy without any dramatic changes in her lifestyle? If I'm reading all what you wrote correctly, highly unlikely, and I believe it's the reality you need to accept NOW. I fully realize all you write about not wishing to crash the spirits of the young girl, but the time of "compromises" might have as well have run out - and now you've only got to be informed of it. Personally, I wouldn't play with the fire in this case. I'd go to meet the professionals and implement everything they advise. I would also cut - not reduce, cut - fructose out of her diet urgently (other than natural fructose that occurs in fruits), both from refined sugars and from the rest of the processed foods where they make up with fructose for the lack of fat and to affect the taste of the food. She's no longer at the point of being able to eat "minimal amounts", whatever it means - she needs to make some drastic changes. You are no longer in a position to choose the preferred method if her health is at stake - and if I'm reading your post correctly, it certainly is.

 

I'm sorry. I know how hard it must be for you, and I know you didn't want this type of answer, but I seriously suggest you not to take this lightly. Go to the doctor soon and be ready for some drastic changes.

:grouphug::grouphug::grouphug:

 

It's just a bump in the road; lots of people live with "conditions". It will be okay. You are a strong mom with a strong dd - that's a brilliant foundation to combat anything that comes your way. :grouphug:

[Julie in CA]

An A1C of 20 would correlate to an average blood sugar of 500+. This is "Let's go to the ICU for an insulin drip" bad. So, I'm pretty sure the number is different or is a different scale. I'd make (and keep) that follow-up appointment. This is life-threateningly serious. The harsh reality is that a poorly controlled diabetic will live a much shorter life-span fraught with a myriad of problems caused by rampant blood glucose. Neuropathy, blindness, renal failure, dialysis, amputations.

 

In agreement with Ester above, she is no longer at a place in her health where she can eat processed foods and "minimally". Everything must be measured carefully. Buy a good diet scale. It's a lot easier to do this now while she is young than it is to try and retrain her when she's older.

We measure food on a scale, but I do see her eating extra as we're cleaning up after dinner. We eat almost no processed foods. Almost is probably not good enough.

[abbeyej]

...I'm pretty sure he doesn't mean to do the referral now. ...

 

Wow. The brunt of your appointment with him may then need to be asking calmly, firmly, repeatedly for the referral. "I appreciate what you're saying, but we've made a concerted effort. At this point, I would like her to see the endocrinologist." And repeat.

 

Get a better understanding of the labs too. But *get*the*referral*.

[extendedforecast]

I have no expertise nor advice, but I do have :grouphug:

I hope you find the support you seek.

[Harriet Vane]

Wow. The brunt of your appointment with him may then need to be asking calmly, firmly, repeatedly for the referral. "I appreciate what you're saying, but we've made a concerted effort. At this point, I would like her to see the endocrinologist." And repeat.

 

Get a better understanding of the labs too. But *get*the*referral*.

 

:iagree::iagree::iagree:

[OHGrandma]

We measure food on a scale, but I do see her eating extra as we're cleaning up after dinner. We eat almost no processed foods. Almost is probably not good enough.

 

Have you tried keeping a log of every bite you(or daughter) takes? Seriously, even tasting the food as you cook, or that last spoonful of batter before washing the mixer bowl, etc? If nothing else, it would be very useful to go over with a dietician. Same thing with an exercise log.

 

And my sympathies are with you, I've struggled with my weight much of my life -- but you can be 'overweight' but still healthy!

[KidsHappen]

PCOS was the first thing that came to mind after reading your post. This can be treated with hormones and allow a person to lead a fairly normal healthy life. Also I don't know if children can suffer from Syndrom X but that is also a possiblity. My hubby has that and they have him on two different meds for dealing with that and natural alternatives for managing cholesterol and trigycerides. I guarantee that they are going to want to retest. Anytime they get a result that is so far outside normal perameters they will retest to make sure they was no comtamination or mistakes during testing. It sounds pretty serious to me so I would make an appt. to retest and one to get in and talk to the dr. yourself right away. Once you know what is going on and understand it and how it is best to be handled then you can bring your dd on board but I wouldn't put it off. IN my experience, dr. and even less so nurses, stress the importance of an immediate follow-up so when they do I pay heed. I hope that you get some answers soon and they everything works out for the best. :grouphug:

[Julie in CA]

(((Julie)))

 

My very first advice? Call first thing in the morning and make an appointment with the Ped ASAP. But just *YOU*. Write down all of your questions and concerns -- including *exactly* what you said here about your concerns for her psychological as well as physical well-being. Go in and ask *all* of your questions. About exactly what the numbers mean right now, about what they will mean for the future, about what you should be doing, about whether you should go to a specialist *now*...

 

But go without your dd. Find out everything you can.

 

And then, once *you're* satisfied that you know what's going on and that you and the ped are on the same page with regard to the way you want to approach your dd, *then* bring her in for an appointment.

I've called and left a message that I'd like an appointment. May I add one more bit of stupidity? If I go in, I'm going to cry. This is not a man who will be understanding about that. It's pretty much condemning myself to not be taken seriously if I cry. He's been a good doc over the years, but not emotionally supportive at all. You're either doing the right thing, or you're not. We're obviously not. :crying:

[dansamy]

She needs a referral to an endocrinologist. Preferably one who is very familiar with endocrine and metabolic issues that affect females. Not every endo is well-versed in these areas. Women's hormones are much different than a man's.

 

Between now and the date that she is seen by an endo, I would record everything that she eats and drinks. It will be helpful to the endo. After seeing an endo, if it still looks like diabetes, I'd keep writing in that journal and insist on seeing a diabetic educator. Bring the journal. And make sure it has everything written down. The grazing, the "occasional" snack, the "just one bite" indulgences. Everything has to be on paper. It's the only way to truly see what's going wrong and right in her diet and exercise.

[Liz CA]

No, I'm not sure. They are sending me a copy of the results so that I can read & research a bit.

 

Julie, I PM'd you.

[LauraGB]

You're either doing the right thing, or you're not. We're obviously not. :crying:

 

Not so, Julie! Sometimes things are predisposed or genetic. Do not beat yourself up over this. She's 12. If the tests are accurate, you are on top of things. Go from there.

[ma23peas]

We measure food on a scale, but I do see her eating extra as we're cleaning up after dinner. We eat almost no processed foods. Almost is probably not good enough.

 

I have to get tough on you here, I know you want gentle, but there comes an obvious point where something you've said is not right. Saying a person exercises, eats less and doesn't lose weight, is just not right. I can say that because I've struggled like you have...I lost 100 pounds my freshman year in college....what changed? EXERCISE...I went from a fairly sedentary lifestyle to walking 6-8 miles a day just to get to class...I didn't have time to eat, but when I did I made sure it was a Serving size of 3 vegetables and a piece of bread (at the college cafeteria)..lunch was a piece of fruit and usually a pack of crackers from the vending machine, and breakfast was oatmeal in my dorm room...you put those two things together (eating portions and exercising) and there is no way you can not lose weight.

 

It felt GREAT to get all that weight off!!! As a teen/young adult, the weight comes off much easier than when you're older...I kept my weight off until my first pregnancy..gained 65! Then had 2 more children in 3 years and in total had a net gain of 75 after all was said and done...I lost those 70 pounds 3 years ago, but then we had 2 house payments for 31 months, and yep, ate myself back..I've lost 25 and have to work extra hard to get it off, my girls have no weight problem, they're actually underweight and physically fit, but my 15 year old 6' is about 30 pounds overweight and I have to MAKE him workout...I get up at 6am every morning and do 2 miles on the treadmill while adding in 22 minutes of strength training with 5 pound weights in each hand (bicep curls, tricep presses, shoulder lifts, rowing motion...all while walking on the treadmill) my heartrate STAYS between 130-150 the entire 45 minutes...then I go swim 30 laps in the pool..I do that 5 days a week and average about 2 pounds a week lost, more if I really keep my calories below 1500....we only do potatoes/corn once a week if that, eat salads 4-5x a week for meals....fresh veggies instead of chips/crackers..the only bread we eat is whole grain, only cereal we get and I'm a meanie, I measured out the cereal several times to show them what a serving was! You don't eat 2 whole grain bagels if you're hungry, you must eat one serving a day but before you reach for that second one, you need to make sure you have that veggie/fruit requirement for the day completed..then if you're still hungry, one half slice....this sounds so restrictive, but I am from a family just like yours, of my genetically linked aunts, only one is within 20 pounds of her recommended BMI rate..some have been as high as 300 pounds! Genetics/nature is not on my side...seems all our veggies have extra calories on them in some form (salad dressing, butter, sour cream, cream cheese, cheese)..try cutting those out...we only let them have sugar drinks (sweet tea/cokes) on birthdays/holidays....we get skim milk but it's pretty much only for cereal, maybe one small glass (I actually had to buy glasses just for milk, because they could pour a 16 oz glass easily!) for some this may seem extreme...but I will give my kids the knowledge of how to choose well (although I still put the weight back on!) and they see how hard I am working to get it gone once and for all....my son is lifting weights, working on his physical fitness badge, is inspired and we encourage each other greatly with high fives and way to go's...we also give ourselves a break, we eat great Monday-Friday, but on Saturday we may have popcorn with butter, but a serving size not an 8 cup eat as you wish bowl!!

 

No juices (loaded with sugar), no cereals with more than 6 grams of sugar..and first ingredient has to be whole grain...lean meats, a portion is less than the palm size of your hand..you go to any restaurant and their dinner portion of chicken/steak is usually 3-4x that....I'll make pancakes on the weekend and we use real syrup..we're not completely void of 'pleasures' but we make it the exception rather than the rule....

 

Write down everything you eat for 2 weeks..show that to your doctor before going in..even a sip of a soda..write it down...

 

Now's the time to not feel sorry about your situation but be strong for your kids, show them the JOYS of living a healthy lifestyle..find an activity you all can do...walking at a local park, school track...take water bottles and tell funny stories as you walk....you can do this!! It is all a matter of eat less, move more....everyone needs at least 50 minutes 5x a week with their heart rate at a workout level, not just moving for 20 minutes...push yourself....you'll feel better, you'll give your daughters a change that should have happened for you when you were a child...

 

I promise if you write everything down and include even if it was fried in canola/olive etc. you'll see a difference....don't forget all the milk/butter added in mashed potatoes...you can only gain if you eat more than you move. The good news is you can only lose if you move more than you eat! :)

 

:grouphug:Tara

[In The Great White North]

Could I suggest taking your dh with you? For your "one on one" appt with the doctor?

 

If you expect to get emotional, and the dr doesn't deal well with "emotional," your dh can at least keep him (dr) on track and ensure you get the referral.

 

IMO, it's harder to be talked into or out of something you know is right when you have moral support right there with you.

[Ester Maria]

I've called and left a message that I'd like an appointment. May I add one more bit of stupidity? If I go in, I'm going to cry. This is not a man who will be understanding about that. It's pretty much condemning myself to not be taken seriously if I cry. He's been a good doc over the years, but not emotionally supportive at all. You're either doing the right thing, or you're not. We're obviously not. :crying:

Julie, the reason why he's there is to help you. And if he's a good doctor, I really urge you to focus on that part: he has the knowledge and the skills needed to help you.

 

There are people whom we might be tempted to classify as "emotionally numb", especially in medical field, since they NEED to distance themselves from the patient-person and look at the patient-instrument (because a human body is, at the end of the day, a very complex instrument that they've studied and can approach "as mechanics", spotting the problem and knowing what to do about it). It's a form of a defense mechanism, in a way - imagine how terribly difficult it would be for them to perform their job properly if they allowed their emotional state to be dependent on that of a patient and their decisions affected by it.

 

He doesn't have to "understand" and he isn't there to be a psychologist - he's there to be an expert for human body and its chemistry who will know what to suggest and what to do. Of course that you, as a mother, cannot step aside and not understand and not take many other things into account - but he HAS to, that's his job. Try to focus not on how he is phrasing things, but on what are those things that he's saying. It's not important that he's emotionally supportive (ideally, he would be, but you're looking for an expert on something else than human emotions right now), it's important that he gives you concrete pieces of useful advice. Try to suspend emotion and cooperate, to the best of your ability. I know it must be very hard with such personalities, but if they're good experts, it's definitely worth it.

 

:grouphug::grouphug:

[Laurie4b]

I've called and left a message that I'd like an appointment. May I add one more bit of stupidity? If I go in, I'm going to cry. This is not a man who will be understanding about that. It's pretty much condemning myself to not be taken seriously if I cry. He's been a good doc over the years, but not emotionally supportive at all. You're either doing the right thing, or you're not. We're obviously not. :crying:

 

All the more reason to get a referral. You really need a doc to work with who is nonjudgmental, helpful, and emotionally supportive right now.

 

Do you have any friends who are nurses or related professions who could go in with you? That could provide emotional support for you and their questions may be taken more seriously.

[Guest Alte Veste Academy]

Wow. The brunt of your appointment with him may then need to be asking calmly, firmly, repeatedly for the referral. "I appreciate what you're saying, but we've made a concerted effort. At this point, I would like her to see the endocrinologist." And repeat.

 

Get a better understanding of the labs too. But *get*the*referral*.

 

:iagree:

 

I've called and left a message that I'd like an appointment. May I add one more bit of stupidity? If I go in, I'm going to cry. This is not a man who will be understanding about that. It's pretty much condemning myself to not be taken seriously if I cry. He's been a good doc over the years, but not emotionally supportive at all. You're either doing the right thing, or you're not. We're obviously not. :crying:

 

Oh, honey, you need a new doctor. If you need to cry and a doctor can't cope with the fact that this is an emotional issue for you, you need a new doctor. Some people are stoic and some people are emotional. Those of us who get emotional when faced with hard, life and death problems, don't benefit from having our feelings minimized. I wouldn't expect to be coddled but I would expect respect. :grouphug:

 

Could I suggest taking your dh with you? For your "one on one" appt with the doctor?

 

If you expect to get emotional, and the dr doesn't deal well with "emotional," your dh can at least keep him (dr) on track and ensure you get the referral.

 

IMO, it's harder to be talked into or out of something you know is right when you have moral support right there with you.

 

:iagree:

 

Julie, the reason why he's there is to help you. And if he's a good doctor, I really urge you to focus on that part: he has the knowledge and the skills needed to help you.

 

There are people whom we might be tempted to classify as "emotionally numb", especially in medical field, since they NEED to distance themselves from the patient-person and look at the patient-instrument (because a human body is, at the end of the day, a very complex instrument that they've studied and can approach "as mechanics", spotting the problem and knowing what to do about it). It's a form of a defense mechanism, in a way - imagine how terribly difficult it would be for them to perform their job properly if they allowed their emotional state to be dependent on that of a patient and their decisions affected by it.

 

He doesn't have to "understand" and he isn't there to be a psychologist - he's there to be an expert for human body and its chemistry who will know what to suggest and what to do. Of course that you, as a mother, cannot step aside and not understand and not take many other things into account - but he HAS to, that's his job. Try to focus not on how he is phrasing things, but on what are those things that he's saying. It's not important that he's emotionally supportive (ideally, he would be, but you're looking for an expert on something else than human emotions right now), it's important that he gives you concrete pieces of useful advice. Try to suspend emotion and cooperate, to the best of your ability. I know it must be very hard with such personalities, but if they're good experts, it's definitely worth it.

 

:grouphug::grouphug:

 

I appreciate what you're saying here but I believe that the emotional needs of human beings should be included in the evaluation of the "patient-instrument." Frankly, maybe those who think otherwise are better suited for another field.

Edited August 17, 2010 by Alte Veste Academy

[i.love.lucy]

Wow. The brunt of your appointment with him may then need to be asking calmly, firmly, repeatedly for the referral. "I appreciate what you're saying, but we've made a concerted effort. At this point, I would like her to see the endocrinologist." And repeat.

 

Get a better understanding of the labs too. But *get*the*referral*.

:iagree: Seeing a ped endo is a completely different ball game than a regular *old school* ped. Let a specialist interpret the numbers. In my area the ped endo is obviously a ped diabetes expert (ds saw her for growth issues) so she has a dedicated nutritionist on staff, trained to help parents with specific issues. Personally, unless your pediatrician has to be the gatekeeper here for insurance reasons, I'd scoot around him immediately and go straight to the endo.

 

And :grouphug:. It'll be okay. Put on your best Mama Bear pants and get after it!

[Perry]

Pediatrician ordered fasting tests which showed no thyroid issues, low cholesterol, but increased Hemo A1C (?) Do I have that right? They told me the level should be way under 17, but dd is at 20. I have no idea quite what those numbers mean, but I'm told that's very *very bad*.

 

I would call tomorrow and ask for the result of the hemoglobin A1c. If they again tell you that it is 20, please tell them you want to come in and have the test redone immediately. I've never heard of an a1c over 13 or 14, and that would be an extreme value in poorly controlled diabetics. More likely, it's a lab mistake or a miscommunication.

 

Did they check a blood glucose (sugar)? Ask for that result. If it's normal, it's impossible for her to have an A1c of 20.

 

:grouphug:

Edited August 17, 2010 by Perry

[Julie in CA]

Julie, the reason why he's there is to help you. And if he's a good doctor, I really urge you to focus on that part: he has the knowledge and the skills needed to help you.

 

There are people whom we might be tempted to classify as "emotionally numb", especially in medical field, since they NEED to distance themselves from the patient-person and look at the patient-instrument (because a human body is, at the end of the day, a very complex instrument that they've studied and can approach "as mechanics", spotting the problem and knowing what to do about it). It's a form of a defense mechanism, in a way - imagine how terribly difficult it would be for them to perform their job properly if they allowed their emotional state to be dependent on that of a patient and their decisions affected by it.

 

He doesn't have to "understand" and he isn't there to be a psychologist - he's there to be an expert for human body and its chemistry who will know what to suggest and what to do. Of course that you, as a mother, cannot step aside and not understand and not take many other things into account - but he HAS to, that's his job. Try to focus not on how he is phrasing things, but on what are those things that he's saying. It's not important that he's emotionally supportive (ideally, he would be, but you're looking for an expert on something else than human emotions right now), it's important that he gives you concrete pieces of useful advice. Try to suspend emotion and cooperate, to the best of your ability. I know it must be very hard with such personalities, but if they're good experts, it's definitely worth it.

 

:grouphug::grouphug:

I'm sorry, I didn't mean to sound critical. I'm truly not. I've appreciated his down-to-earth style for almost 20 years. He's been through some hard times with our family. This same dd contracted meningitis when she was 8 weeks old, and after a 3 week long hopital stay during which she was very close to death, I relied upon the knowledge of this doc right up until the point he let me know the situation was beyond his expertise. I value him as a doc, and don't expect him to hold my hand, but I'm aware of the fact that he will not respond well to emotional reaction on my part. We've been through the diet/exercise discussion before, and I'm not eager to be told to rely upon a defense that we haven't been able to successfully achieve, in spite of efforts to do so. We really have been trying the right things, I think, and though we'll redouble our efforts, can we realistically rely upon enough improvement to turn things around? The overweight--this is not a kid who's eating so much extra as to have gained 43 lbs over the past 2 years! She's not sitting in front of the television watching tv either. She gets at least 30 minutes of aerobic activity almost every day. How much will be enough? I guess I'll go and ask, but it's difficult to see things worsening even though we've made such positive changes.

Edited August 17, 2010 by Julie in CA

[Ester Maria]

I appreciate what you're saying here but I believe that the emotional needs of human beings should be included in the evaluation of the "patient-instrument." Frankly, maybe those who think otherwise are better suited for another field.

I do write with the assumption that there is respect towards the patient, of course. My comment doesn't apply to doctors who are outright verbally aggressive, for example, or in some other extreme ways provoke a truly bad atmosphere in the office. But, seeing that OP has stated herself that she has been in fact "pleased with the service", in lack of better expression, over the last years, I assumed her doctor might not be in that group, or she would have changed the doctor already. That's where my comment stems from, since sometimes it's merely an emotional detachment issue (which is an unofficial "prerequisite" for being in the medical field and working with people, otherwise your life would be a horror if you took all of your patients' problems to heart), but a doctor is a good doctor nonetheless. Some of the best specialists I've been unlucky enough to get in touch with were very "cold" persons, and yet helped tremendously. :)

I do see what you're saying though, but I think that we're talking about two different profiles of doctors here.

 

I do agree that she should get a referral, if possible - to a person who is a narrower specialist in the issue.