August 17, 2000
Honeymoon
Question from Kumla, Sweden:
My nine year old daughter has had diabetes type 1 since she was four years old. We are doing just fine and she is still on two shots a day of mixed insulin. We have managed to keep her HbA1c almost in a normal range. Lately, I’ve been wondering whether or not she still could have a very small insulin production of her own. I feel this would be of a great interest since that would mean that she also produces a small amount of C-peptide. Since recent research shows that C-peptide could be of importance in the prevention of diabetic complications, I would really like to find out if she has any production of her own and will ask her doctor to test her for this. If you have a small insulin production left even after four and one-half years with diabetes, could you prolong this production by being a little bit “aggressive” in your insulin treatment in order to let the functioning beta cells “rest” a little?
Answer:
Firstly, I am surprised to hear of any patient in Sweden on twice daily mixed insulin because all my experience of diabetes care in your country suggests that this is very rare with the majority of patients on multiple injection therapy. However, I am a very pragmatic person, and, if she is doing so well on twice a day pre-mix, then you certainly should not change. The evidence in relation to prolonging the ‘honeymoon’ period by using aggressive blood sugar control is still a bit shaky, but there is no doubt that the maintenance of good control is an extremely laudable aim in itself. Working on the basis of your daughter’s weight and insulin dose, your paediatrician will be able to tell you (roughly) how much of her insulin requirement she makes herself — i.e., she doesn’t need C-peptide measurements.
KJR
