University College Hospital. Blood glucose and HbA 1 c targets

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1 University College Hospital Blood glucose and HbA 1 c targets Children & Young People s Diabetes Service The diabetes team at UCLH aims to help every child and young person with Type 1 Diabetes to safely spend as much time as possible with a blood glucose level within the target range. Time spent in target is important for long term health. Blood glucose targets The range for blood glucose targets is between 3.6mmol/L and 9mmol/L. We recommend aiming for a normal blood glucose level, this means: Waking (fasting) and pre meal blood glucose levels should be between 3.6 and 6.9mmol/L After meal/food (2-3hours) blood glucose levels should be below 9mmol/L. Before physical activity and exercise blood glucose level should be between 5 and 7mmol/L Please see table below for blood glucose levels and the relevant action and treatment advice, recommended by the UCLH team.

2 BG level mmol/l Less than 3.6 BG too low (Hypoglycaemia) BG level at low end of target range BG level in target range BG level above target if done before a meal BG level too high (hyperglycaemia) Above 14 BG level too high (hyperglycaemia) & risk of DKA Treatment advice Treat with glucose (2-15 grams depending on age of child) See hypoglycaemia If showing symptoms of or feeling hypoglycaemia, or BG dropping quickly treat as if hypo N/A correction insulin if about to eat a meal or snack correction dose of insulin See correcting high blood glucose level Check for ketones correction dose of insulin See sick day rules (pump or injections) Insulin Check Blood Glucose 15 minutes after hypo treatment If hypo just before starting a meal, delay giving insulin bolus for meal until after eating meal. If about to eat a meal/snack and using a pump/meter bolus calculator, the dose of insulin will be automatically reduced to bring BG up to middle of target range If about to eat a meal/snack and using a pump/meter bolus calculator, the dose of insulin will be automatically calculated By using a pump/meter bolus calculator, the dose of insulin will be automatically increased to match both the carbohydrate eaten and bring BG level back down to target range. By using a pump/meter bolus calculator, the dose of insulin will be automatically calculated to bring BG back to target range. Check BG 1 hour later if on a pump Check BG 2 hours later if on injections Change insulin cannula (if using an insulin pump) if BG does not come down after initial correction If ketones below 0.6, follow advice above ( mmols/l) If ketones above 0.6, insulin dose calculated by pump/meter bolus calculator needs to be overridden and increased (see sick day rules ). All correction insulin needs to be given by injection Change insulin cannula if using an insulin pump Check BG and ketones in 1 hour

3 HbA 1 c Targets The HbA 1 c target recommended by NICE (2015) for children and young people with diabetes is 48mmol/mol or 6.5%. HbA1c gives an idea of what your blood glucose has been averaging over the last 3 months. The term HbA1c refers to glycated haemoglobin. It develops when haemoglobin, a protein within red blood cells that carries oxygen throughout your body, joins with glucose in the blood, becoming 'glycated'. Red blood cells live for three months in the blood before they are replaced, so measuring how much glucose gets stuck tells us how much glucose has been around over those three months. In someone without diabetes the HbA1c is usually between 20 and 41mmol/mol or 4-5.9%. Large studies have shown that the higher the HbA1c, the greater the risk of developing long term complications. The graph below is from the Diabetes control and Complications Trial (Skyler, 1996) and shows the risk compared to the general population of developing eye (retinopathy), kidney (nephropathy) and nerve (neuropathy) problems if your HbA1c runs at high values for more than ten years. HbA 1 c is checked every 3 months at clinic but you can keep track of diabetes management by either looking at your average blood glucose levels over 7,14, 30 days or looking at time spent in target on your blood glucose meter or pump download.

4 The table below will help you to predict where your HbA1c is going to be. HbA1c Means your average blood glucose level is IFCC DCCT 40mmol/mol 5.8% 6.6mmol/L 48mmol/mol 6.5% 7.7mmol/L 52mmol/mol 6.9% 8.4mmol/L 57mmol/mol 7.4% 9.2mmol/L 65mmol/mol 8.1% 10.3mmol/L 70mmol/mol 8.6% 11.1mmol/L 85mmol/mol 9.9% 13.2mmol/L 100mmol/mol 11.3% 15.4mmol/L 130mmol/mol 14% 19.7mmol/L Using downloads Downloading blood glucose meters and insulin pumps every 7-14 days helps to keep track of blood glucose levels and insulin adjustments that may be needed. Have a look at the summary screens to get an overview of where you are. On Diasend use the Compilation screen to view average blood glucose levels and time spent in target.

5 On Carelink use the sensor and meter overview page to look at time spent in target. Managing blood glucose levels on a day to day basis is important to increase the time spent in target. Always try to manage high and low blood glucose levels as they happen but remember to review insulin doses based on the time spent in target regularly. Spending lots of time with high or low blood glucose levels means your insulin doses or pump settings may need adjusting, contact the team for support with this. Contact Details: Office Hours (Mon-Fri 9am to 12pm): (Children s Diabetes Nurses) Emergency mobile (Mon-Fri 8am 6pm): Out of Hours: and page Paediatric On-call Registrar uclh.cdlime@nhs.net or uclh.cdorange@nhs.net Further information and fact sheets can be found on our Children and Young People s Diabetes web page at First published: 19/07/13 Date last reviewed: 09/08/2018 Date next review due: 09/08/2020 Leaflet code: UCLH/SH/PAED/CYPDS/HbA1c/2 University College London Hospitals NHS Foundation Trust