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

[Julie in CA]

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:

I'm sure I must have the numbers wrong. I asked for them to send me a copy of the results, but I'll probably be going in before it arrives.

[Julie in CA]

So is it worthwhile pushing a bit for the referral, even if the numbers look just fine to the ped.?

[DianeW88]

30 minutes of aerobic activity is enough to MAINTAIN weight, but NOT lose it. She needs at least 50 minutes per day, 5-6 days per week as well as strength training to build muscle (muscle burns more calories than fat does) and some sort of yoga/Pilates type of exercise to promote stretching and prevent injuries. She also needs to do the aerobic activity to the point of being able to talk but not sing. It needs to be vigorous. If a gym membership would be feasible, I would suggest that. She could do the treadmill or take some of the fun classes and if you could get a personal trainer to work with her.....even better.

 

Diane W.

married for 22 years

homeschooling 3 kiddos for 16 years

[RahRah]

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*.

 

A pediatric endo is a must.....this could be pre-pubescent PCO rearing it's ugly head, Cushings, simple IR with diabetes, or some other metabolic anomoly.

 

The A1C is a measure of average blood sugar levels over three months (the period of time a red blood cell functions and circulates before cell death). Over 6% indicates pre-diabetes or diabetes - situation is confirmed with a fasting blood sugar and a two-hour oral glucose tolerance test.

 

The extreme weight gain and slight humping on the back - Cushing must be ruled out.

 

The high A1C and weight gain - T2 diabetes confirmed or ruled out with Cushings testing.....T1 and LADA will also need to be ruled out if her insulin levels are lower than normal, which could explain the seriously elevated blood sugars indicated by the A1C.

 

The brown skin on her neck is acanthosis nigricans - a thickening, darkening of skin, usually found at the back of the neck, elbows, behind knees and in/around other joints where AGE's (advanced glycated end-products - basically sugar crystals) accumulate in the presence of habitually high blood sugars.

[Ester Maria]

So is it worthwhile pushing a bit for the referral, even if the numbers look just fine to the ped.?

Yes, and very much so!

By what you described, the whole situation, your daughter is going to profit from a visit to a more narrower expert even if the numbers aren't as alarming as the ones brought up.

[Amy loves Bud]

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

 

Yes! Please follow up with the doctor and ask specifically about Cushing's.

[creekmom]

I recommend buying a blood sugar monitor and testing strips at Walmart or the drug store. Test her blood sugar when she first wakes up - fasting # below 100 is normal. 101 -126 fasting is prediabetes and over 126 is diabetes. Also, test her blood 2 hours after the first bite of a meal. Ideal # is under 140. If she is over this number, you can try adjusting her diet. If that doesn't work, medicine might be beneficial. The a1c # is a more accurate measure of blood sugar because it gives you the average blood sugar level over a period of weeks. Most dr.s are more interested in the a1c bc it tells how well your body is handling the foods you eat regularly. It's possible to eat a healthy dinner with minimal carbs and wake up with a good fasting # - even if you're diabetic. The fasting # is good to know because if it is high, you definitely want to change the dinner menu. Test her a lot and keep track of the foods that don't cause a spike and foods that do. Don't be scared- be pro-active. You'll breathe a sigh of relief when you feel more in control. Don't play the blame game. I'm 5'6 and 115 lbs. and prediabetic. My sil is extremely overweight and not diabetic. It is not a death sentence- it is a lifestyle change. It will be OK- just don't go into denial. Become an expert on diabetes and the way to manage it! Your daughter needs you! :001_smile: :grouphug:

[Gooblink]

I agree that H-A1C reading can't be correct. I have a diabetic child and neice - neither of theirs has ever been above 13 (even before insulin therapy).

 

I will say that our pediatrician/family doctors didn't even know what to look for or how to diagnose a diabetic child. Our doctor - who has a great reputation - ordered blood work when they found glucose in my son's urine. But, because the blood work didn't show elevated BG, he dismissed me when I asked about diabetes. We took him to an endocrinologist and she recognized the clues from the blood work immediately.

 

Be persistent until you know. :grouphug:

[katemary63]

I don't have time to read all the replies so I don't know what people have suggested but..... I just want to say that my DH and I and all three adult kids struggle with weight because of family genetics that include thyroid disease and insulin resistance.

 

If you have been trying to reduce portion size but have not been weighing your food, then you have not been reducing protion size. I am only saying this as one who has found out the hard way. My DH, DDs and I are now counting calories by weighing our food and HOLY COW! were we eating too much and thinking we were eating less. Get a good scale and weight everything you eat. I know it sounds hard, but we are doing it, all four of us, so I know it can be done. And you know what, after this last month, WE LOVE IT!

 

We love it because we have gained some freedom within the boundaries of eating healthy. Instead of feeling out of control or guilty, we eat what ever we want within a nice set of guidlines. We stay within a certain number of calories and try to keep our fat at less then 30% and our carbs low too.

 

We are keeping track of our eating on www.fatsecret.com. It is FANTASTIC! It is so easy to look up your food items, make a recipe, make a menu! It's all so easy and we just love it. We even track our weight on it. Our family has lost a combined 70 lbs. so far! We are all buddies on fatsecret and can chat or check up on each other's eating.

 

We are also eating 75% whole grains, really cutting out the suger and white flour. For someone like you and your daughters, sugar should just be off the list, at least until a goal weight is reached. I know it can be done, I am a sugaraholic and have not had a single dessert item since Jan 1, 2010. When I need something sweet, I make myself a fruit smoothie. It satisfies.

 

I offer you my best wishes and encouragement for the difficult road ahead, but it is well worth it. I have lost 25 lbs, have 55 more to go and I'm feeling so good and am so excited about loosing more! You can all do it! But I honestly don't believe you can succeed unless you weigh your food, at least until you have the hang of the amounts that equal your calorie allotment. At least, that was the key for us!!! Good luck! and God Bless.

[Ottakee]

So is it worthwhile pushing a bit for the referral, even if the numbers look just fine to the ped.?

 

YES< YES< YES

 

I would push for a pediatric endocrinologist ASAP as this could still be thyroid or other endo issue. The lab norms have changed and not even all labs are up to date and not all doctors are up to date.

 

The endo can help you figure this out and they will have a dietician and other support staff to help you with any diet changes, support, etc. that you need.

 

Is she on any medication at this point? Some meds have huge weight gain as a side effect as well.

[Mom2absh]

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!

 

Julie,

 

This just gripped me - this is not right. Do what you have to do to get a referral to a specialist. Your DD has seen this ped her whole life - I don't think he has anything more to tell you to help her.

 

He told you to watch what she eats and to make sure she exercises. You did that. You did that 100x better than some parents would ever dream of doing. It didn't help. That means something else is going on, something your ped is not considering - it may not even enter his head to consider it.

 

That doesn't make him a poor doctor. It just means YOU have to advocate for her. Tell him you appreciate all he's done, but you would like a second opinion about what's going on with her. Don't worry about what he will think of the request, or your family, or you as a mother, or anything like that. You don't have to justify yourself to him, or get him to agree with you - you just have to get the referral.

 

:grouphug::grouphug::grouphug: You are a great mom, and you are doing a great job taking care of your daughter!

 

Blessings,

J

[KidsHappen]

I don't know if you have looked into this or no but in our health plan we do not need a referral to see a specialist. We can make an appoinment directly with them. Check that out and if it is the case then you can still get her in to see who she needs even without a referral from your doc.

[jazzyfizzle]

Hi Julie,

 

First- :grouphug:

 

I became a Type 1 diabetic as an adult 7 years ago. No history of diabetes ever for me, or anyone in my family. There is a history, like mentioned by other posters, of PCOS.

 

For the immediate, I would second the suggestion to go right now to the drug store, purchase a meter and strips. Many of them are low cost. Some meters you need to 'code' when you start a bottle of strips, some you do not now. Either way it is not difficult.

Set the meter up, prick her finger and check her numbers. The numbers Creekmom listed sound good to me also. If you get readings like those, say anything from 80- 125, you can breathe easier right now. If you get readings above this, something is going on. Maybe nothing too major, or maybe major, all depends.

If you see readings like that listed A1C suggest- like- 400-500, make arrangements, calmly pack up DD and drive to the ER. They can bring the numbers down to the safe zone fairly quickly. These types of readings will not be caused by meals eaten and processed by a 'normal' body. A normal body will keep the blood sugar in the 'safe zone' on its own, even with eating a high carb meal or say, a big dessert.

I have lived through readings above 900 (when we were learning what was happening- just to give you an idea- it is a high danger zone). I wont' go into the details here, but would be happy to talk in PM or email about it.

I don't know if I would say 500 is going cause immediate body failure, but any high reading over time will cause much damage to the body, especially very high numbers like that. The higher the reading, the duration/length of high readings, all affect to damage the body- just either slower over time (with mild or moderate high readings, or quicker (with high readings) in general terms. Damage that occurs is not reversible. Hopefully this makes a bit of sense.

 

You are not in Canada, correct? Their chart has different numerical readings than the U.S. chart. If I read it corrrectly, their chart would put a 20 at around 360 our chart.

 

I would be happy to help in any way I can.

 

ETA- I would also suggest to go ahead with the Ped. Endo visit, even if you get safe readings on the meter, just to be on the safe side. Sounds like something of some sort is going on.

 

Sending good thoughts (( ))

Edited August 17, 2010 by jazzyfizzle

[Denisemomof4]

I think you'r blaming yourself for your dd's issues, even though you have made significant changes in the past year or so. I think you need to give yourself credit while still being concerned for your dd. Something just doesn't sound right. It may be genetics, but the weight gain and what you say you eat??? I'd cut back on fats for sure, limit cheese, eat lean meats.

 

Quinoa is the grain with the lowest carb count. Legumes are good.

 

Fats from nuts are what have carried me through meals when losing weight. They really do fill me. Raw nuts are PACKED with enzymes and nutrients. I count them as good fats so I didn't limit them in the past.

 

I also hate getting emotional in front of drs and have avoided them because of it. It's not wise, especially in your situation. You're being a good mom. If you cry, you cry. It's ok.

[Sugarfoot]

I read your post to my DH and he immediately said, "They need to rule out Cushing's." All of the diet and exercise changes are great, but a real health problem could be underlying it all.

[LaissezFaire]

Hi Julie,

 

First- :grouphug:

 

I became a Type 1 diabetic as an adult 7 years ago. No history of diabetes ever for me, or anyone in my family. There is a history, like mentioned by other posters, of PCOS.

 

For the immediate, I would second the suggestion to go right now to the drug store, purchase a meter and strips. Many of them are low cost. Some meters you need to 'code' when you start a bottle of strips, some you do not now. Either way it is not difficult.

Set the meter up, prick her finger and check her numbers. The numbers Creekmom listed sound good to me also. If you get readings like those, say anything from 80- 125, you can breathe easier right now. If you get readings above this, something is going on. Maybe nothing too major, or maybe major, all depends.

If you see readings like that listed A1C suggest- like- 400-500, make arrangements, calmly pack up DD and drive to the ER. They can bring the numbers down to the safe zone fairly quickly. These types of readings will not be caused by meals eaten and processed by a 'normal' body. A normal body will keep the blood sugar in the 'safe zone' on its own, even with eating a high carb meal or say, a big dessert.

I have lived through readings above 900 (when we were learning what was happening- just to give you an idea- it is a high danger zone). I wont' go into the details here, but would be happy to talk in PM or email about it.

I don't know if I would say 500 is going cause immediate body failure, but any high reading over time will cause much damage to the body, especially very high numbers like that. The higher the reading, the duration/length of high readings, all affect to damage the body- just either slower over time (with mild or moderate high readings, or quicker (with high readings) in general terms. Damage that occurs is not reversible. Hopefully this makes a bit of sense.

 

You are not in Canada, correct? Their chart has different numerical readings than the U.S. chart. If I read it corrrectly, their chart would put a 20 at around 360 our chart.

 

I would be happy to help in any way I can.

 

ETA- I would also suggest to go ahead with the Ped. Endo visit, even if you get safe readings on the meter, just to be on the safe side. Sounds like something of some sort is going on.

 

Sending good thoughts (( ))

 

I fully agree with this post. Get a meter and do some self-investigating. My dd was misdiagnosed several times by dr's who just put up blinders because they truly thought it was one thing and it was diabetes all along. I also agree that the level of 20 has to be wrong. The highest I have ever heard of for hba1c is 17 and that girl was constantly hospitalized. The darkening of the skin around her neck scares me significantly so I would start doing some tests at home with a meter. If you can rule out diabetes then it's time to move on to other metabolic or endocrine issues. Get in with a ped endo as SOON as you can. It's scary, I know. But with blood sugar issues your child really could die tomorrow. It's not something to wait and see on.

[theresatwist]

I agree with a lot of what has been said.

 

Have you tried making healthy eating and exercise into a game or maybe even a family challenge? I wouldn't base winning on losing weight because I would be afraid that that sort of game might lead to an eating disorder. But how about seeing who can eat the most servings of vegetables at dinner? Or who go running the most days in a row on a regular basis? I just think turning attempting to lose weight and healthy living generally into a game might make it a little less of a drag. I think if other family members and maybe even friends who don't necessarily even need to lose weight were to get involved it might make this all a little less punitive for your daughter.

[Lawana]

As the mother of a Type 1 diabetic, I am familiar with A1c's, insulin and blood sugar. Please let us know when you get the A1c number again from your Dr., so we can get an idea of how out of range your dd is. A high A1c shows that the blood sugar is too high.

 

In general, as carbohydrates are digested, they are all broken down to simple sugars, glucose being the main one. Even 100% whole wheat will yield glucose as the main end product (along with some protein and fat). Glucose is *not* the enemy. Cells use glucose as their main energy source. The body can convert protein to glucose if necessary. Also, the body can utilize a different substance, ketones, as an alternate fuel source if glucose is in extremely limited supply (such as on a carbohydrate free diet or fasting). Using ketoes as energy is generally considered to be a mechanism to survive famine.

 

When all body systems work well, blood sugar is tightly regulated. As carbs are ingested, the pancreas releases insulin that allows the glucose that has been absorbed by the gut, and passed into the blood stream, to enter the cells to be used as fuel. Think of insulin as the "key" that allows glucose to pass from the bloodstream into all the cells of the body. In the absence of insulin, glucose would build up in the blood.

 

In the phenomenon of "insulin resistance," insulin is released by the pancreas, but is not readily "recognized" by the cells. So the concentration of glucose increases in the blood, triggering more insulin to be released. One of the effects of increased circulating insulin is to direct excess energy to be stored as fat, rather than burned off as heat. As fat accumulates, the body tends to become more insulin resistant, and the cycle spirals in the direction of more weight gain. Some people seem to be more affected by this than others.

 

As the body's systems are vastly complicated, when something disturbs the natural controls, things can get seriously out of whack. Given your family's tendencies, it seems very possible that your dd has something quite "off" in her physiology, specifically her endocrine system. Other posters have made the point that an endocrinologist would be the best bet in helping you through this ordeal.

 

Be wary of dieticians if they seem married to the USDA food pyramid. There are good ones out there, but in my experience, they may be hard to find. If you come across one that recommends lots of vegetables, particuarly raw green ones, and insists you eliminate processed carbs, you are on the right track.;) Salad, and lots of it, is your friend. And not because it's a "diet" food. It is packed with nutrients and fiber.

 

My dd, 13, has Type 1 diabetes. She doesn't have significant insulin resistance, ...yet. She also weighs 160 lbs, is done with her height growth, but is still putting on the pounds. So this is more than theoretical to me. I daily try to find the balance between insisting she eat healthily, without unintentionally pushing her into an eating disorder, not uncommon with Type 1's. In our case, dd clearly does not get enough activity, and *always* craves carbs. White. refined. nasty. carbs. It doesn't help that her 11 yo brother is *always* hungry, and is *always* eating, but is slender. Of course, he is much more active than his sister.

 

Please ask more specific questions as you think of them. And don't let anyone try to tell you that she can't possibly be eating reasonably/getting enough exercise and still be gaining weight. There may be, in fact, improvements that you need to make, but there are also disorders of the endocrine system that throw the normal energy intake/energy storage balance out of whack. Eliminate those possibilities before you beat yourself up.

 

Meanwhile, one of the simplest things you can do is to eliminate all soda, for everyone in the family. Never keep it in the house. If an adult has to have it, insist it is consumed outside of the house, not in the presense of anyone struggling with weight issues.

 

:grouphug:I wish you the best in getting this all sorted out. If I can be of any further assistance, please PM me.

[cjbeach]

Ageeing that a HgA1C of 20 can't be right if you walked out of that office without an rx or referral to an endocrinologist.

I found as a whole, I really like most endocrinologists. Since your doc is not someone you feel comfortable with to begin with, please ask for a referral for an endocrinologist to further investigate endocrine issues.

 

please update us when you find out the results and get that referral!!!!

 

But, does you doc have an office nurse you can ask to read off the results to you and get your started on a referral? Better yet, do need a referral with your insurance or can you just go without referral?

 

ETA- Re: diet/The first diet/nutrition advice you'll be given if her hgba1c is elevated is leaning carb control. CArb counting is key in diabetic management.

I have a very good friend who attends Food Addicts Anonymous and the basis of the program is realizing how many people have a true sugar addiction (white sugar/white flour). Her breakfast is: small pack of oatmeal, 4 oz yogurt, a fruit. I *believe* Lunch and Dinner is : 4 oz protein, 6 oz cooked veg, salad. They believe in pre-making foods so they'll be readily available (she weighs and measure all of her food on Sundays incl salads, veggies, proteins. She hardboils 6 eggs at a time - she eats 2 for lunch with cucumbers and a salad each day at work). NOtice that the carbs (oatmeal and to a lesser degree the fruit) are eaten in the morning to burn up throughout the day. She craved carbs and had no energy, now she has a lot more energy and the carb craving is much more under control.

Edited August 17, 2010 by cjbeach

[Julie in CA]

As the mother of a Type 1 diabetic, I am familiar with A1c's, insulin and blood sugar. Please let us know when you get the A1c number again from your Dr., so we can get an idea of how out of range your dd is. A high A1c shows that the blood sugar is too high.

 

In general, as carbohydrates are digested, they are all broken down to simple sugars, glucose being the main one. Even 100% whole wheat will yield glucose as the main end product (along with some protein and fat). Glucose is *not* the enemy. Cells use glucose as their main energy source. The body can convert protein to glucose if necessary. Also, the body can utilize a different substance, ketones, as an alternate fuel source if glucose is in extremely limited supply (such as on a carbohydrate free diet or fasting). Using ketoes as energy is generally considered to be a mechanism to survive famine.

 

When all body systems work well, blood sugar is tightly regulated. As carbs are ingested, the pancreas releases insulin that allows the glucose that has been absorbed by the gut, and passed into the blood stream, to enter the cells to be used as fuel. Think of insulin as the "key" that allows glucose to pass from the bloodstream into all the cells of the body. In the absence of insulin, glucose would build up in the blood.

 

In the phenomenon of "insulin resistance," insulin is released by the pancreas, but is not readily "recognized" by the cells. So the concentration of glucose increases in the blood, triggering more insulin to be released. One of the effects of increased circulating insulin is to direct excess energy to be stored as fat, rather than burned off as heat. As fat accumulates, the body tends to become more insulin resistant, and the cycle spirals in the direction of more weight gain. Some people seem to be more affected by this than others.

 

As the body's systems are vastly complicated, when something disturbs the natural controls, things can get seriously out of whack. Given your family's tendencies, it seems very possible that your dd has something quite "off" in her physiology, specifically her endocrine system. Other posters have made the point that an endocrinologist would be the best bet in helping you through this ordeal.

 

Be wary of dieticians if they seem married to the USDA food pyramid. There are good ones out there, but in my experience, they may be hard to find. If you come across one that recommends lots of vegetables, particuarly raw green ones, and insists you eliminate processed carbs, you are on the right track.;) Salad, and lots of it, is your friend. And not because it's a "diet" food. It is packed with nutrients and fiber.

 

My dd, 13, has Type 1 diabetes. She doesn't have significant insulin resistance, ...yet. She also weighs 160 lbs, is done with her height growth, but is still putting on the pounds. So this is more than theoretical to me. I daily try to find the balance between insisting she eat healthily, without unintentionally pushing her into an eating disorder, not uncommon with Type 1's. In our case, dd clearly does not get enough activity, and *always* craves carbs. White. refined. nasty. carbs. It doesn't help that her 11 yo brother is *always* hungry, and is *always* eating, but is slender. Of course, he is much more active than his sister.

 

Please ask more specific questions as you think of them. And don't let anyone try to tell you that she can't possibly be eating reasonably/getting enough exercise and still be gaining weight. There may be, in fact, improvements that you need to make, but there are also disorders of the endocrine system that throw the normal energy intake/energy storage balance out of whack. Eliminate those possibilities before you beat yourself up.

 

Meanwhile, one of the simplest things you can do is to eliminate all soda, for everyone in the family. Never keep it in the house. If an adult has to have it, insist it is consumed outside of the house, not in the presense of anyone struggling with weight issues.

 

:grouphug:I wish you the best in getting this all sorted out. If I can be of any further assistance, please PM me.

We do a lot of salads, probably at 3/4 of the dinners we eat, and several times per week additionally at lunchtime. We've phased out iceberg completely, and are now using a mix of romaine and baby spinach for our salad greens. Progress.

 

It is a bit of an issue, about the eating habits of brothers. My three teenage boys are constantly ravenous, which makes sense, since they're all growing so fast and are all currently between 6' and 6'4". I remind the girls (and we laugh about the fact) that no one can eat like a teenage boy, besides a teenage boy!

 

As for the soda, I don't buy it, ever. She occasionally has soda when she's out with her dad, or with a friend. I think I can put a stop to that completely fairly easily.

 

Thank you for posting. :001_smile:

[Julie in CA]

Ageeing that a HgA1C of 20 can't be right if you walked out of that office without an rx or referral to an endocrinologist.

I found as a whole, I really like most endocrinologists. Since your doc is not someone you feel comfortable with to begin with, please ask for a referral for an endocrinologist to further investigate endocrine issues.

 

please update us when you find out the results and get that referral!!!!

The pediatric endocrinologist comes to our area once per month. I'm not sure we can get in without the referral just on that basis. Does it need to be the pediatric endocrinologist, or would a regular endo be good enough?

[forevergrace]

Hey Julie,

It is always scary to try something new. Especially, a doctor you've grown to trust and that has become part of your family experiences. But, it is o.k. to try a different way. Sometimes, different people (doctors, alternative medical practitioners, etc.) will have different ideas, and different degrees of education. I applaud you for being so honest, and willing to take the next necessary steps. Think of this as a wake-up call, you now can figure out what must be done.

Praying for you and your family,

Forevergrace

[celticmom]

The thing that jumped out at me about the post was the weight issues in all of the Women in the family. I would definitely look into female hormone issues if I were you. My family history is similar. My mother had to have a complete hysterectomy when I was very young for ovarian cysts. I had to have emergency surgery for ovarian cysts in my late 20s. In the year after the operation I lost over 40 lbs. My weight gain/loss tends to be very connected to whether my reproductive hormones are in balance or not. In my case I have also discovered that I cannot tolerate medications that are synthetic hormones and I cannot eat animal products from animals that have been given synthetic hormones. I can only eat organic or bgh free dairy. I can only eat organic eggs. The main category of animal products that I can eat relatively freely is fish and seafood. This is the approach that I have found that works for me.

[Forget-Me-Not]

My DH is a family practitioner and was reading your post over my shoulder. He said she needs to be tested for Cushings too. BTW, if it is Cushings, she'll gain weight almost no matter what you do with her. His words: "Big red alarms" going off in his head over the info you've given here.

 

Do you *have* to have a referral to go to an endocrinologist? You might double check if you aren't sure. My insurance doesn't require a primary's referral to approach a specialist. If you need his referral, it ABSOLUTELY merits insisting, demanding a referral. Even if you have to throw yourself under the bus: "I know I'm probably just a paranoid mom, Dr, but I would feel much better if she was evaluated by an endocrinologist blah blah blah." (if you think that sort of thing might work with him).

 

Good luck and Mama Bear vibes to you!

[Harriet Vane]

So is it worthwhile pushing a bit for the referral, even if the numbers look just fine to the ped.?

 

Absolutely. Go ahead and push, and do not accept anything other than that referral. The situation you describe IS cause for concern, most definitely. (:grouphug:)

 

This is a worthwhile stand to take.

[HollyinNNV]

Julie,

 

I am a physician. I am posting this message after my wife showed me this. First of all, I want to state that there are 2 reporting methods for Hemoglobin A1c levels; IFCC-HbA1c (Europe and Canada) and DCCT-HbA1c (US). Although I have never seen IFCC levels reported in the US, this will be the eventual standard and perhaps your lab is ahead of the curve, but I highly doubt it. DCCT-HbA1c levels are reported as a percentage (%), while IFCC-HbA1c levels are reported as mmol/mol, so it should be easy to determine which one you have. So, I will assume that your result has been reported under the current US standard of DCCT-HbA1c (%).

 

What is HbA1c? It is a measure of the amount of hemoglobin molecules in red blood cells that have had glucose molecules attached to them (called glycosylation). HbA1c is measured to give an idea of average glucose levels in the blood over a period of 3 to 8 weeks. The higher your average blood sugar level, the higher your HbA1c. I am not passing judgement here, but merely stating facts. In my 10+ year career, I have only seen a HbA1c level over 20 a handful of times. This is an indication of extremely poor control.

 

There is actually an equation that you can extrapolate the average HbA1c to an average blood sugar:

 

Average Blood Sugar = 28.7 x HbA1c -46.7

 

Based on this, your DD's average blood sugar would be 527!!

 

A normal blood sugar is < 120 mg/dL. Therefore, an average of 527 is more than 4 times normal. Based on the concept of an "average," this means that half the time, your DD's blood sugar is ABOVE 527 and half the time it is below 527.

 

There are 2 possible causes for this. The first is a lack of production of insulin by the body. This is typically seen in Type 1 Diabetes, also known as Juvenile onset Diabetes. The second cause is a resistance of the body to insulin, aka Adult-Onset Diabetes or type 2 Diabetes. However, the term is a misnomer; in the US, we are seeing "adult-onset" diabetes in younger and younger patients due to the increasingly obese population in the US. Insulin resistance is caused by several things. Although there is probably a genetic predisposition, lack of physical activity and obesity are typically the cause. Based on your posts here, I am guessing that your DD has type-2 Diabetes.

 

How is this treated? Well, the obvious diet and exercise issues have been mentioned exhaustively here, so I will not mention it specifically except to say that you DO need to schedule that appointment with your PCP to discuss this with him or her. However, IMHO, this will not be sufficient in the short term to get your DD's glucose levels under control. There are several adjuncts to help in glycemic control that fall into 2 basic classes; oral hypoglycemic agents and insulin analogs. Your DD's probably has insulin resistance and her body can not produce sufficient amounts of insulin to get her blood sugar under control and will probably need insulin in the short term and perhaps oral hypoglycemics and/or insulin in the long term to maintain an acceptable blood sugar level. Down the road when she loses weight and gets on some sort of exercise regimen, perhaps these agents can be discontinued.

 

Lastly, I wanted to point out that there have been numerous studies linking high HbA1c levels to complications and mortality. One of the largest, a study of over 47,000 diabetics found an increase in morbidity and mortality in diabetics with HbA1c levels greater than 6.5%. Just food for thought. . . .pun intended. High blood sugars and diabetes eventually lead to a host of other problems, including heart disease, kidney disease/failure, peripheral nerve damage, eye problems including cataracts as well as diabetic retinopathy. The list goes on and on.

 

If this were my DD, here's what I would do:

 

1. Drastically limit processed foods, including junk food and white breads. You would be surprised how much food has high-fructose corn syrup. Even foods you wouldn't consider to be sweet. NO regular soft drinks.

2. Buy fruits and vegetable for snacks.

3. Go to your PCP and talk about diet and exercise issues

4. Get a blood glucose meter and check it regularly

5. Get on a medication regimen including either oral hypoglycemics or insulin or both.

6. DO the diet and exercise!

7. Follow up with your PCP and make changes based on your repeat lab work.

 

Hope this helps ;)

 

Shane

[Carol in Cal.]

Julie, There are great books to help with figuring out the whole diabetes thing. Some include "Reversing Diabetes" by Whitaker, and "Diabetes: Your First Year."

I also like to suggest that people who look at changing their diets radically read up on heart disease as well so that they don't end up changing from a high carb to a high fat diet and mess up their hearts. "Reversing Heart Disease" by Ornish is pretty good there.

 

:grouphug:

[mhg]

I didn't read other posts as it 1 am and I'm up secondary to tonight's anniversary date and drinking too much caffeine. So...I'll try to be coherent.

 

Before SAHM I worked in the health profession, so I'll weigh in on this.

You are doing the best for your family and your kid by seeking proper care about this issue. The darkening at skin folds is called acanthosis nigricans --- it's a long latin word for darkening at skin folds secondary to issues related to glocose control and cortisol secretion issues. It is commonly seen in ladies with PCOS (polycystic ovarian syndrome) which we NOW know is a gyne issue directly linked/resulting from underlying glycemic control (meaning how her body manages insulin/glucose/ -- in easier terms: how well her body uses its energy). Think of insulin as the hormone that acts as a KEY to let the energy (glucose) into the cells. Your daughter's glucose levels are likely extremely high for the HgbA1C to be this high. She needs to have this glucose/diabetes issues manages aggressively. Follow the advice of her doc to the T ! Miss NO appointments. Diabetes can damage numerous body systems.

 

From what you describe your daughter has diabetes (type 2). Diabetes and some of its associated problems such as metabolic syndrome, polycystic ovarian syndrome, etc. cause certain physical adaptations/changes in the body and these patients often have some/many of the following symptoms:

*** overweight with weight usually deposited in upper part of body (truck, neck, face, etc.) -- they usually have thinner legs/thighs relative to their upper bodies.

*** acanthosis nigricans (darkening of skin esp at areas of creasing/folds -- neck, elbows, where neck joins front/clavicle area, pubic region...where thighs touch labia, etc.)

*** male pattern hair distribution (meaning they tend to have male-like more coarse hair distributed in areas where usually only men get the hair such as chest, chin, moustache (sp?), back, upper thighs, more in pubic area than women, etc.

*** not uncommon to see menstrual delays (in menarche) or menstrual irregularity

*** not uncommon to see relatively smaller breasts (smaller than one would expect on their relatively larger overweight bodies)

*** acne

*** and, if ovary is affected, its not uncommon to see numerous cysts on the ovarian that can OVER TIME (NOT NOW, MOM!) lead to the ovarian lining becoming thickened and resistant to normal release of eggs (leading to numerous cysts and potentially negative affect on F U T U R E fertility).....again.....not now, momma and only if left untreated/unmanaged OVER TIME!

*** very common to see abnormal HgbA1C levels

*** very common to see abnormal cholesterol levels

*** one more aside/FYI: young girls whose father's are bald/partially bald (not receding hairlines, but BALDING on TOP) are more than 4X more likely to have this problem. (don't need to answer...but is her dad bald?....I know this sounds crazy but I once heard a fascinating lecture by Dr. Allen Thorneycroft on the genetic link on this subject).

 

Thankfully you have caught this EARLY and can intervene. Many young ladies go into their 20s and 30s and aren't diagnosed with any problems and the long term sequelae (outcomes) can be damaging.

You are ON THE BALL here to catch this with her being only 12! That's great. In addition to her regular physician, she needs to see an endocrinologist (preferably an endocrinologist AND a reproductive endocrinologist) to have all of her hormones evaluated. She needs have cushing's syndrome ruled out as well. She needs to have her lipids (cholesterol) checked to ensure this is within normal ranges. She needs to have FSH/LH levels checked at least annually to make sure the ratio is correct/proper (don't have time to explain this here) but her endocrinologist will know about this. Now......these will likely be normal, but a 12 year old child with the symptoms you described NEEDS to have this checked as this is an issue which PREVENTION is worth 100 lbs. of cure. My response is focused more on the GYNECOLOGICAL issues associated with abnormal GLUCOSE levels. Of PRIMARY importance is of course that she get this blood sugar under control as soon as possible, but....then/soon you need to have the reproductive endocrinologist evaluate her as well.

 

And, only you know if she's the kind of kid that would sneak/hide food.....and with these levels, it needs to be prevented at all costs.... Somehow she has to understand the seriousness of this without getting more stressed out (stress--leads to cortisol---leads to desire to eat carbs :-( )......but what I mean is that the ENTIRE family has to get behind her on this issue. It's a delicate walk of communicating the URGENCY without making her more anxious.

 

At this EARLY stage and in light of her young age, there's NO need for you to PANIC, but there is a need to be vigilent as you get control of this asap. You've done the PERFECT thing for her to have this evaluated.

 

And.....I wouldn't share this treatise with her. You, as her mom, just need to keep these things in mind for you to discuss with her doctor. You're ABSOLUTELY right in not making her anxious about this. With proper management this can be completely helped and hopefully restored.

 

I will say that RARELY is the advice given with regard to diet and exercise aggressive enough for people with you and your family's genetic tendencies towards overweight. I'd STRONGLY consider following Dr. Joel Fuhrman's EAT TO LIVE book/plan (his newest book is Eat for Health ---- I'd get the audio CDs of his books if you have the funds for them.....they're awesome!). I've typed toooooo long to go into my reasons for why I'm sure this will SOOOOO help and possibly (probably) heal your daughter, but if you read it you'll understand. www.drfuhrman.com is his website. He's the one Mehmet Oz refers HIS patients to (if that tells you anything). When it comes to nutritional EXCELLENCE, he is THE authority BAR NONE! And he has an entire chapter on diabetes and his results are unparalleled (and I've met them firsthand). Don't have time to go into what he's done in my own life....but if you take NONE of my other advice, please put this on your list.

 

Hope this helped. Feel free to PM me as needed.

(too tired to spellcheck....sorry).

 

Best wishes!

Edited August 17, 2010 by mhg

[Mom0012]

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. :grouphug:Tara

 

You know, I always believed the bolded part above was true. I've been thin most of my life except during a short period during the teen years before I learned about calories and exercise. Once I understood that, I had always maintained my weight. After my son was born, I lost the baby weight with no problem. Same with my daughter. A couple of years after my daughter was born, I slowly started to gain weight. When I saw I was putting on a few pounds, I ate 1200 calories a day and exercised and expected to drop it like I always did. Didn't happen (and I was only 32). I'd be very strict for 2 weeks and lose 1/2 a pound. Then, if I ate a little extra even one day the next week, I'd gain it back.

 

I fought very hard just not to gain weight, but over the next few years I gained 15 pounds.

 

A couple of years ago, my doctor noted that my thyroid levels were borderline, but we decided not to treat because they were still within the normal range. This last year, I finally got diagnosed with Hashimoto's and my thyroid levels were just slightly above normal. Going on a low dose of thyroid meds has given me back my energy, my memory and my ability to lose and maintain my weight again.

 

So, you can be eating right and exercising and not losing weight if you have hormonal or other issues going on. That was always hard for me to believe until I experienced it myself. I am very fortunate that I have the doctor I do, because I think a lot of doctor's would have blown off my numbers since they were only slightly elevated.

 

Lisa

Edited August 17, 2010 by LisaTheresa

[Pamela H in Texas]

Diabetes is cure-able (don't ask the ADA).

 

The diets that cure it and that are disease preventing in other ways are vegan and raw. After you get those numbers back in line, you can slowly add a little animal products if you wise.

 

BTW, this is what we did!

 

And there is so much to experiment with that it can really make a big difference in how you see food. Honestly, I had a love/hate relationship with food; but I finally can enjoy it!

 

I also want to point you to the story in the front of Jon Gabriel's book. Some of his stuff is a bit hokey but I like how he allows you to ease into nutrient-dense eating (rather than a 6 week "jump in the deep end" like Fuhrman which works fine with someone like me but maybe not for someone eating closer to SAD in the first place). Anyway, but the story in the front talks about the story of a cat who was just a normal cat and ended up starving himself to obesity, basically.

 

Anyway, I was terrified about my sugar after it being high for YEARS. I did the diet stuff for another reason but imagine my surprise (and my endocrinologist's pleasure!) when it came back NORMAL. And it's been normal ever since. No medication, I bounce on and off diets, I do as I please. But I don't have a sugar issue.

 

I hope some of this gives you some hope. There is a documentary available online about eating raw to cure diabetes. The Eat to Live email group is VERY active (and you can also enjoy his blog and website and of course the book).

 

BTW, if you are more interested in exercise to lose weight (like not modifying diet radically), you might try something like the BeachBody videos or Dr. Huizenga's book (he's the dr from Biggest Loser). There is no doubt exercise works. But there may still be some sugar issues with a typical weight loss diet (usually it gets better, but won't cure).

Edited August 17, 2010 by 2J5M9K

[LizzyBee]

The pediatric endocrinologist comes to our area once per month. I'm not sure we can get in without the referral just on that basis. Does it need to be the pediatric endocrinologist, or would a regular endo be good enough?

 

Can you go to an endo in the nearest city so that you have someone who will be available any time your dd needs an appt and not just once a month?

[southcarolinamom]

I haven't read through every post here, but just wondering ...

 

Was her A1C supposed to be done "fasting?"

 

And if so, could your dd have eaten something before the blood test that would have skewed the results?

 

I'm sorry your family is going through such a scary health situation right now. Please keep us posted. :grouphug:

[Catherine]

Hemoglobin A1c simply gives you a number that reflects where a person's average blood sugar has been over the past 6-8 weeks. Unfortunately, I've seen plenty over 12! Yet those reflect extremely poorly controlled diabetes, so it seems doubtful that 17 could be accurate in your daughter's case. I wonder if they actually measured fructosamine, a test designed to give similar information to that given by the Hgb A1C.

 

Ditto the check for Cushings, and for polycystic ovarian syndrome (sometimes called PCOS). Women and girls with PCOS are vulnerable to type 2 diabetes. Is your daughter menstruating yet, has she had any periods at all? The endocrinologist will want to know this, so it's a good idea to ask her to start keeping track now, even if she has light spotting some days.

 

It's a shame if her doctor has caused you or her shame or bad feelings over this or anything else. That's unprofessional IMO.

[Catherine]

Type two diabetes is. There's a significant difference. Type ones make no insulin and will die without it within a week. Type twos make plenty of insulin.

[Gooblink]

=Pamela H in Texas;1961246]Diabetes is cure-able (don't ask the ADA).

 

Type 1 diabetes is not curable, though. If your body is not producing insulin, no diet and exercise change is going to fix it.

 

All the advice given about making diet changes and checking BG is great, but if you're up against Type 1 diabetes, you're simply increasing the risk that your dd is going to end up in the emergency room.

 

Don't wait a month to see an pediatric endo. just because of insurance, for heaven's sake. If you have to pay out of pocket and drive a couple hours to get your daughter the care she needs...do it.

 

ETA: I hope my tone of urgency doesn't come off as "harsh." :( You are doing the right things and obviously anxious over the health of your dd. I'm not trying to add to your burden. ((hugs))

Edited August 17, 2010 by Gooblink
clarification

[Tree House Academy]

I have no advice as I don't understand those numbers. However, as a mother, I do understand the fear, the feelings of "have I failed them" and for that, I just wanted to let you know that you and your sweet dd are in my prayers.

[Teachin'Mine]

:grouphug:

 

Julie I've got no medical advice, but what strikes me is that your daughters are young, you've already been working in the right direction to help them get healthy, they're active - so no it's definitely not too late. Make up a list of questions to ask the doctor and ask him not only to explain things to you, but to give you some written info that you can read later and absorb. He may also be able to direct you to some books or websites for further info. It helps to know as much as you can, so you know what to do.

 

It sounds like you're an awesome mom. :) I agree with your gentle approach and I'm sure that armed with better info, you'll be able to help them make better progress. Keep up the good work. :)

[Julie in CA]

Wow, you packed so much information into one post! Thank you.

A couple of comments, and a question...

Dad's not bald. :001_smile:

 

Her cholesterol was 137. They said those numbers all looked great.

 

At this point she isn't sneaky about food, and I'd like to prevent her from becoming so if I can. I think that's part of my resistance to bringing her along with me to see the doc. There's got to be a way of taking a hard line about nutrition without making her feel horrible about herself. I really want to find it. :confused: Actually, I thought I *was* finding it, gradually, but time seems to have run out in terms of gradual change...

 

I know how to do low-carb, because I already know that I seem to have some problems when I eat carbs. I stay away from them. I do best on about 25 carbs per day, almost all of those from veggies. I don't lose weight, but I feel really good eating that way. I have not checked out Eat to Live, but I will. From the snippets I've heard here and there, I had the impression that it would be extremely difficult for me to implement for the family, but I've never checked it out enough to know. I'll find that today.

 

And lastly, my question...

Since the labs were a precursor done according to the protocol requested by the ped. endo., would they not have included whatever was needed to diagnose Cushings? (Okay, I just went and Googled, and read a bit about Cushing's, and I see that the testing required probably could not have been accomplished by a single blood draw, right?)

 

I woke up this morning feeling calmer, and with a bit more resolve. I'm pretty sure if I go into the appointment with the frame of mind that I'm fairly certain something else is going on, even if the preliminary labs didn't show it, I can get through without an unwelcome emotional response. I don't mean that I'm going to give up on the diet/exercise aspect, just that it seems to me there's really got to be more to it, and it'd be worth pursuing a bit farther before deciding that *all* of this can be laid at the feet of poor dietary and exercise choices. I just don't think our habits are horribly bad enough to cause all of this. I'm going to do more work on it on my end, but it seems reasonable to keep seeking a few more answers.

 

Thank you.

[Julie in CA]

Hemoglobin A1c simply gives you a number that reflects where a person's average blood sugar has been over the past 6-8 weeks. Unfortunately, I've seen plenty over 12! Yet those reflect extremely poorly controlled diabetes, so it seems doubtful that 17 could be accurate in your daughter's case. I wonder if they actually measured fructosamine, a test designed to give similar information to that given by the Hgb A1C.

 

Ditto the check for Cushings, and for polycystic ovarian syndrome (sometimes called PCOS). Women and girls with PCOS are vulnerable to type 2 diabetes. Is your daughter menstruating yet, has she had any periods at all? The endocrinologist will want to know this, so it's a good idea to ask her to start keeping track now, even if she has light spotting some days.

 

It's a shame if her doctor has caused you or her shame or bad feelings over this or anything else. That's unprofessional IMO.

I really think I must have the number wrong.

No menstruation yet. I didn't start until I was 13 1/2, and older dd didn't start until she was 13 1/2, so I didn't expect anything yet from this dd.

[StephanieF]

Would keeping a food diary be useful so that you can show the dr what a typical day looks like? You wouldn't need to be too accurate but just note down approx portion size and what dd ate and drank?

Stephanie

[Penelope]

I hope you get some answers from your doctor soon.

 

I just wanted to speak to exercise, in general.

 

30 minutes is better than nothing. But, 30 minutes of aerobic exercise even most days of the week, is not enough for anybody, let alone a growing child, unless the rest of the day already includes a significant amount of activity. If someone is basically sedentary the rest of the time, then 30 minutes is not going to counteract that much. 45-60 minutes of moderate to vigorous aerobic activity, 6 days a week, is what is better for weight loss, but also, just incorporating more activity into daily life. Walking places instead of driving. Getting a pedometer might be fun and motivating for a 12 year old, too.

[AuntieM]

:grouphug::grouphug::grouphug:

 

You are a good momma!

 

You have gotten a lot of great info. I would only add a couple of things. First, if there's any way of not waiting on the endo to come to you, take it. In your shoes I would try to take dd in to the nearest large city children's hospital. Once you have a diagnosis, then you can follow through with your sorta-local guy. It will cost time and money but I would truly consider it if you feel you are not getting swift, thorough answers from your current doc.

 

Also, if I needed for my entire family to get deadly serious about breaking a sugar addiction, I would look for a 10 to 14 day "vacation" at a spa or health center that can help you do a sugar detox. I know it sounds drastic, and perhaps your knee-jerk reaction is that it would be impossible, but it would help you all (at least you and your daughters) break the cycle. At the same time, it would allow you to be "in the trenches" with your DDs, helping them through emotionally without the added stress of having to prepare all the meals. I do realize this sounds drastic (extravagant? frivolous?), but initially breaking that carb addiction can be tough.

 

At the very least, a diagnosis of diabetes should get you a referral into an education program with a nutritionist specializing in diabetes. But you will have to prepare yourself to be the Food Police Force in your home. I have teenage boys, too, along with my teen dd. It *is* hard to satisfy them both while keeping portions healthy for the gals.

 

Try not to worry about crying in front of the doctor. I probably would, too. Just keep your dd's needs in the forefront of your mind and make it clear to him that you *must* have answers.

 

You are being proactive, that's great! You *will* get through this!

[DianeW88]

Also, Julie, do not accept that according to the test numbers "there is nothing seriously wrong". Definitely get her into someone else. If your current doc won't give you a referral, get her test results and find another primary who WILL! As a ped nurse, all kinds of alarm bells are going off in my head with your description of your dd's symptoms and that test result. Something is SERIOUSLY wrong and needs to be addressed VERY quickly....as in TODAY! (Not shouting, just emphasizing.) If you can't see another doc and that A1C is really 17.....go to the ER. If you can swing it, take her to the ER of a children's hospital. She needs prompt medical attention.

 

Please keep us updated. I've been thinking about her since last night. Hope your appointment goes well.

 

Diane W.

married for 22 years

homeschooling 3 kiddos for 16 years

[Julie in CA]

Don't wait a month to see an pediatric endo. just because of insurance, for heaven's sake. If you have to pay out of pocket and drive a couple hours to get your daughter the care she needs...do it.

 

It's not a matter of insurance at all. My hesitation stems from the fact that the only pediatric endo. is over 100 miles away, and comes to our area once per month. I'm also willing to drive the distance--no problem, but I've also heard that his schedule is full in his regular practice, and that other than referrals that stem from an obvious need to see him, he's not accepting new patients. I'm not sure how to go about seeing a pediatric endo. unless her ped. is on board with it. :confused: If it were within my ability to do so, I'd make an appointment *today*.

[sarahf.]

Type 2 may be curable but my son is a T1D and there is no "diet cure" for him...I wish!

 

Diabetes is cure-able (don't ask the ADA).

 

The diets that cure it and that are disease preventing in other ways are vegan and raw. After you get those numbers back in line, you can slowly add a little animal products if you wise.

 

BTW, this is what we did!

 

And there is so much to experiment with that it can really make a big difference in how you see food. Honestly, I had a love/hate relationship with food; but I finally can enjoy it!

 

I also want to point you to the story in the front of Jon Gabriel's book. Some of his stuff is a bit hokey but I like how he allows you to ease into nutrient-dense eating (rather than a 6 week "jump in the deep end" like Fuhrman which works fine with someone like me but maybe not for someone eating closer to SAD in the first place). Anyway, but the story in the front talks about the story of a cat who was just a normal cat and ended up starving himself to obesity, basically.

 

Anyway, I was terrified about my sugar after it being high for YEARS. I did the diet stuff for another reason but imagine my surprise (and my endocrinologist's pleasure!) when it came back NORMAL. And it's been normal ever since. No medication, I bounce on and off diets, I do as I please. But I don't have a sugar issue.

 

I hope some of this gives you some hope. There is a documentary available online about eating raw to cure diabetes. The Eat to Live email group is VERY active (and you can also enjoy his blog and website and of course the book).

 

BTW, if you are more interested in exercise to lose weight (like not modifying diet radically), you might try something like the BeachBody videos or Dr. Huizenga's book (he's the dr from Biggest Loser). There is no doubt exercise works. But there may still be some sugar issues with a typical weight loss diet (usually it gets better, but won't cure).

[ktgrok]

I agree that the Eat to Live type diet may be too difficult to do for the whole family right away. Honestly, I think that your daughter is going to need to restrict carbs, and as you probably know that is hard enough. I would not worry about fat/calories at first, just get the sugar and carbs gone, then you can tweak. The big issue is to get her blood sugar down, and to do that without making her feel deprived i'd let her have everything else, as much as she wants, until those cravings are gone.

[Homeschooling Hannah]

I'm so sorry and feel your pain. My son has asthma and trying to learn how to deal with it was very hard at first. Eventually it should come easy for you.

I said a prayer for you.

Sincerely,

Debi

[naturegirl7]

HA1C is a blood test that measures your blood sugar over the course of 3 months. It is the blood test that determines whether or not you are diabetic, and how well your diabetic program/meds is working for you.

I am not familiar with the kids levels - but in adults, you want it under 6-7.

 

 

Honestly, I would recommend making the appt - if nothing else, they can explain everything to you about her labwork and maybe help put the nutrition and fitness thing into an easier program for her to follow.

 

Drastic changes may be really hard - but it just may save your daughter's. Please don't take my words as harsh or that I am saying that she will die. That is NOT what I mean at all - I mean quality of life. And her future health.

She is still a child, it will be easier for her to make the lifestyle changes now to ensure a healthier future for her and her own children. Drastic changes in her current lifestyle can likely reverse the pre-diabetes or diabetes diagnosis. Her body is under strain right now and simply can not keep up.

 

Diabetes is a very hard disease to live with and to manage - it leads to lots of other problems too - kidney disease, heart disease, and neuropathy (nerve damage to your limbs) just to name a few. I am a nurse and I take care of people all day long who are diabetic - some more brittle than others, it is scary (even as a professional) to watch someone have seizures simply cuz their blood sugar is too high or too low. Or to see them slowly lose one toe at a time or chunks of their feet due to neuropathy, vascular disease, and inability to help the smallest wound.

 

 

:grouphug: to you and your daughter. I personally know how incredibly hard it is to make drastic diet and lifestyle changes for the health of your child. My son has EXTENSIVE food allergies and is honestly allergic to almost all "normal" food. It turned our world upside down at first. But after 6 months of sticking with it, it was alot easier - and the changes made it so worth it; he was suddenly healthy again and growing for the first time in almost a year. By a year, it was just a way of life. Now almost 4 years later, it is totally second nature, and even though he is weaned and I could go back to eating most of the foods I onced loved, I have not cuz I am so much healthier without them and really teh craving for those things isn't there any more - plus I have found lots of great replacements. I would not have done it for myself - but for my child, I'd fly to the moon and back.

It isn't easy, but you both CAN do it. GL!

[naturegirl7]

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*.

 

 

This link may help put it into perspective for you

 

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

 

 

HA1C should be no more than 7, which equals a blood sugar of 170. Fasting for a healthy, non-diabetic person should be 70-120. So you see there is already an issue with it being a bit high at 7.

HA1C of 12 is a blood sugar of 345. For each point it basically increases about 35 points.

 

Which means that a HA1C of 20 would be a blood sugar of 625.

 

That is dangerously high. Most of the testing meters stop reading somewhere between 450-500. Please follow up on this.

[Lolly]

It sounds to me like you have the right diet idea in mind. Since a pediatric endo is so far away, I would probably make an appt with the regular endo.

 

As to her exercise level, my kids usually get an hour of intense exercise a day (minimum). You might want to try increasing that gradually. Twice a day would be even better! Truthfully, I think kids really need more like 2 hours of aerobic exercise in a day. Some are able to get it by playing in the neighborhood. Maybe if you start the day off with an hour of brisk walking after breakfast. Then, in the afternoon, have another one hour exercise session of something more intense. Normal kid stuff (at least what I've seen these days) isn't enough for most kids.