From Charlotte, North Carolina, USA:
My 13 year old daughter has had diabetes for four months treated with Lantus (insulin glargine) and Novolog from the beginning, and she has had full control of her sugars since she was diagnosed. She is excellent in counting her carb intake and staying away from "junk" food. Her last hemoglobin A1c was 5.3%, and her doctor says she is in a huge "honeymoon." She started on 14 units of Lantus at nighttime with 1 unit of Novolog for 12 grams of carb, now she is on 5 units of Lantus, and 60-70 mg/dl [3.3-3.9 mmol/L]! We have been coming down one unit every couple of weeks because her doctor said the Lantus isn't supposed to make her low. Now my question is if she continues like this, can she come completely off of Lantus?
Her doctor wants to check her blood for those antibodies. What does that mean if they are negative? We do not have any diabetes in the family, so we have been wondering all along if she might have something else. What do you think? They did not do a glucose test on her. Should they have?
The honeymoon is an encouraging, but sometimes confusing, time. You can become (too) hopeful that the whole diagnosis was a mistake, but it is uncommon to misdiagnose type 1 diabetes (relative to simple causes of hyperglycemia). On other occasions, it is sometimes difficult to distinguish type 1 from type 2 diabetes (but still clearly different than no diabetes.)
I don't understand what you mean that they did "not do a glucose test on her." They must have! You can't have diabetes without establishing an elevation in glucose! Maybe you mean that they didn't do a glucose tolerance test on her? That is not required to establish a diagnosis in most cases.
The honeymoon is tricky, if you take away too much insulin, her own pancreas has to "work harder" and will compromise future insulin reserves/production. Studies show that prolonged honeymoon phases are positive events (and part of the basis for the theories on diabetes prevention trials).
You do not have to have a family history of diabetes, but many children with type 1 do have a family history of other autoimmune diseases which may include thyroid disease, pernicious anemia (Vitamin B12 deficiency), lupus, rheumatoid arthritis, vitiligo, and others. Are you indicating that pancreatic antibodies were not done for your child at the beginning? That is too bad, but it's not too late to do them now. I would not do insulin antibodies but ask them to do GAD65 and ICA512 or IA2 antibodies in a reliable lab that measures these antibodies often. If positive, then you have that reality to deal with. If negative, that does not exclude the diagnosis of type 1 but will be a bit more encouraging. Talk diligently with your daughter's pediatric endocrinologist!
Original posting 15 May 2002
Posted to Daily Care
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Last Updated: Tuesday April 06, 2010 15:09:34
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