Understanding Blood Sugar Ranges and A1C in Children and Teens with T1D

Managing Type 1 Diabetes (T1D) as a parent can sometimes feel like a balancing act, especially when it comes to blood sugar targets and test results. It’s normal to feel anxious when numbers don’t always sit where you’d like them to, but remember: these results are not a “report card.” They are simply information that helps you and your child’s diabetes team understand what’s happening in their body and make adjustments, if needed.

What Are Normal Blood Sugar Ranges?

NHS and NICE guidance gives target blood glucose ranges for children and young people with Type 1 Diabetes:

• Fasting/ before meals: around 4-7 mmol/L

• 1-2 hours after meals: ideally under 8-10 mmol/L

These are targets, not strict rules. Blood sugars will often be above or below these numbers, and that’s okay. The aim is to reduce time spent very high or very low, not to achieve perfection 24/7.

What is HbA1c and Why Does It Matter?

HbA1c (often just called “A1C”) is a blood test usually done every 3-6 months at clinic.

• It measures the average blood glucose levels over the past 8-12 weeks

• The result is given as a percentage (%) or in mmol/mol in the UK or mg/dL

• For most children and teens with T1D, the target is 48 mmol/mol (6.5%) or below, though this may be different depending on individual circumstances

Why it matters: HbA1c gives the “big picture” of overall glucose management. It helps your diabetes team see if adjustments are needed- whether that’s insulin doses, timing of injections, pump settings, changes to nutrition, or supporting activity levels.

Don’t Stress Over the Number

It’s very common for HbA1c results to rise during certain stages of life- especially puberty, when hormones and growth spurts naturally make blood sugar harder to manage. Stress, school exams, illness, and changes in routine can also make numbers shift.

Instead of worrying about one result, think of it as feedback:

• Does insulin need adjusting?

• Is your child more active (or less active) lately?

• Are hormones or stress playing a role?

Numbers are there to help guide decisions- not to judge progress.

Continuous Glucose Monitoring (CGM) and Time in Range

Many children and teens in the UK now have access to continuous glucose monitoring (CGM) through the NHS. These devices track blood sugar levels every few minutes via a small sensor under the skin, and results can be viewed on a phone, receiver or pump.

Why CGMs can make a difference:

• Time in range (TIR): Instead of just looking at HbA1c, CGM shows the percentage of time your child spends between 3.9-10 mmol/L

• Early alerts: Alarms can warn about rising or falling blood sugars before they become urgent

• Patterns, not guesses: CGM data highlights trends (like night-time highs or after school lows), making it easier to fine tune insulin and daily routines

Improving time in target range often leads to a more stable HbA1c without needing to chase “perfect” numbers all the time. For many families, a CGM can bring peace of mind and help children feel more confident in everyday activities.

Blood Sugar Is About More Than Food

It’s easy to assume that blood sugar levels are only about what your child eats, but many other factors play a role, including:

• Hormones (puberty, periods, growth)

• Stress and adrenaline (exams, sports, excitement)

• Illness or infections (even mild colds can raise levels)

• Inflammation or injury

• Sleep patterns and fatigue

Recognising these influences helps reduce blame or guilt when numbers don’t make sense- they often aren’t just about food or insulin.

What If You’re Not Happy with Your Child’s HbA1c?

First, take a breath. It’s completely normal for HbA1c to move up and down over time. If you feel unhappy with a result, try these steps:

1. Talk to your diabetes team- They can review insulin settings, mealtime ratios, or suggest technology like CGM or pump adjustments.

2. Look at trends, not one-off readings- Small daily patterns (e.g. breakfast spikes, overnight highs) are often more useful than the overall number.

3. Set one small goal- Instead of overhauling everything, choose one thing to focus on, like checking bedtime readings or adjusting snack choices.

4. Remember the long game- Type 1 Diabetes management is lifelong. Children and teens are learning skills they’ll carry into adulthood. Perfection isn’t the goal- balance and safety are.

The Bigger Picture

Supporting a child or teen with Type 1 Diabetes means recognising that good days and tricky days will always exist. HbA1c is a helpful tool, but it doesn’t define your child’s health or your efforts as a parent. What matters most is keeping them safe, learning along the way, and maintaining a positive relationship with food, activity and diabetes care.

Stay reassured: every family’s journey looks different, and with time, both you and your child will continue to build confidence in managing T1D together.