From Oklahoma, USA:
My son was diagnosed 6 years ago in 1992, at age six with Type 1 diabetes. His blood sugar was 360 when diagnosed in the hospital. We have seen a pediatric endocrinologist since his diagnosis. His blood sugars have continued to be less than 100 usually in the 80 to 90 range for the last six years. His Alc tests have all been less than 5.5. I would like to know the longest known honeymoon period and if these numbers indicate continued insulin treatment? His insulin dosage has not changed in six years since his initial diagnosis. At the time of his diagnosis he weighed 40 pounds, he currently weighs 90 pounds. His insulin dosage is 3R and 1NPH morning and 3R and 2NPH in the evening. My son feels that at this point he shouldn't have to take the shots. The few times that he has not taken a shot his blood sugars have remained constant.
If your son is of average weight I calculate that he is now getting a little less than one quarter of the usual dose of insulin for a boy of his age. Besides which his blood sugars and A1c's appear to be normal to all intents and purposes.
From a practical point of view I would discuss with his doctor whether he could not now be managed on an even smaller dose of insulin as NPH or Ultralente given only once a day. The longest honeymoon period that I have come across in his age group was about two and a half years in identical twins so I suspect that the explanation of his story lies elsewhere.
The first step might be to ask whether in 1992 he had an antibody test on diagnosis. If he did and it was positive; then he has some variety of autoimmune or Type 1A Diabetes; but possibly one that has not led to irrevocable loss of all insulin producing ability. It has also recently been recognised that in some cases of diabetes in childhood the onset may be just like in Type 1A; but with a negative antibody test. After a number of weeks the ensuing course can be managed without insulin with diet, exercise and perhaps oral medication. A little over half the new onset cases in Hispanic and African American have this Type 1B category; but in Caucasian children it is less than 10%. There are some other very rare forms of diabetes in which the pattern is rather like that shown by your son. It is difficult nonetheless to make a definitive diagnosis partly because the underlying pathology is still not clearly understood, although some are chromosomal; but also because the necessary tests are done in far flung research labs and consequently very hard to arrange.
My guess is that your son will do equally well on the suggested reduced dose of insulin and that he has in fact got Type 1B Diabetes. The question will then arise as to whether he could come off insulin entirely. At this point it would be helpful to have some idea as to whether he is producing some of his own insulin and the test that you should discuss with his doctor is getting a serum C-peptide done. In any case there would be little harm in trying him off insulin if the first step is successful and seeing whether he could be controlled on diet and exercise or also required some oral medication, perhaps on of the ones that increase the sensitivity of the insulin receptor. Whatever the outcome the paramount need is to maintain his excellent control.
Original posting 2 Sep 1998
Posted to Honeymoon
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Last Updated: Tuesday April 06, 2010 15:09:00
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