My 14 year old son was diagnosed with diabetes four months ago. His islet cell antibodies were negative but his GAD-65 was 4.3. He is doing extremely well with one unit of Ultralente at breakfast and dinner combined with one unit of Humalog with every meal. Are there any precautions available to prolong this honeymoon period and are there any complications to be aware of from his GAD-65 results?

I showed your e-mail to the doctor who does our antibody testing and he was not able to comment on the figure for anti GAD because it was on a different scale to ours, but I will assume that it was positive. There have been many attempts to prolong the honeymoon period and big trials are going on in the US and in Europe to see if either small doses of insulin by injection or orally or the vitamin nicotinamide will do this. In the past, a number of other drugs have been tried and the only one that was successful was with a medication called cyclosporin. However, after a year or so, there was a significant risk of kidney damage. The only other successful attempt that I know of has been the use of nicotinamide in antibody positive school children in New Zealand. In this study, daily nicotinamide seems to have deferred insulin dependence in about 60% for as long as eight years, but, if the vitamin was stopped, clinical diabetes soon followed. In trials where insulin was already needed, nicotinamide had no effect.

The only important complication to avoid at this stage is severe hypoglycemia at a time when you are trying to balance diet, exercise and insulin dose so as to keep blood sugars as near to normal as possible. I am sure that this is something that your diabetes team has already talked to you about.

DOB