From Melbourne, Victoria, Australia:
Our son is 12; he was diagnosed 2 weeks ago with Type 1 diabetes. We got it early. He is on minimal insulin at present. Could you please explain the "honeymoon" period and the advantage of giving insulin whilst he produces a large amount of his own still? Could this be treated orally with hypoglyceamics? If not, why not? What are long term gains by starting insulin now?
The destruction of the islets or insulin producing cells in Type 1A or autoimmune diabetes takes months or even years and by the time supplementary insulin is required and diabetes is apparent clinically, over 90% of the body's ability to produce insulin has been destroyed and destroyed permanently.
A good many years ago, at a time when meticulous control was not thought to be so important in children, it was quite common to discontinue insulin and use sulphonylurea oral drugs during the honeymoon period, which is a time of transient recovery of minimal insulin production. What this did was to shorten the honeymoon period; but much more importantly it encouraged families to feel that a permanent recovery might be possible and thus to distract them from the enormously important task of getting used to the disciplines of being a diabetic and learning the skills of meticulous blood sugar control. In addition the disappointment at having to resume insulin sometimes led to significant emotional disturbance.
If you have any doubts about your son having autoimmune diabetes you should talk to his doctor about an antibody test; but since you live in Melbourne I expect that this might already been done.
Just to complicate the picture, it is now realised that about 10% of new onset diabetics in a Caucasian population do not have the autoimmune form (these figures hold for the U.S. and I would suspect that the figure is much lower in Australia). This is called Type 1B and just exactly what the pathology is has not been fully worked out although some of them are known to have a chromosomal abnormality. The onset in these children is exactly the same as in the more common form and they have the typical honeymoon period; but after a few months many of them can move to oral medication. This group are, of course, antibody negative.
Original posting 23 May 1998
Posted to Honeymoon
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Last Updated: Tuesday April 06, 2010 15:08:58
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