My five year old daughter, diagnosed with type 1 diabetes about 16 months ago, is still in her honeymoon phase, I believe, and with the promise of the islet cell transplantation I’ve read about I would like to keep her in this phase as long as possible to hold onto her beta cells. I’ve also read about the use of chromium and nicotinamide in helping to restore or preserve beta cells. Are these supplements available in a liquid form? How much should I give her with the least possible side effects? She weighs approximately 45 pounds.

Sixteen months, whilst by no means exceptional, is getting near the end of the likely honeymoon period so that I think you need to talk to your daughter’s diabetes team about how sure they are that she has type 1A (autoimmune) diabetes. A positive antibody test at the time of diagnosis would of course settle the matter and might still if her insulin requirements are less than 0.3U/kg.body wt/day. I say this because it might be that she has the much less common type 1B form of diabetes which has a similar onset clinically, but the antibody tests are negative. It comprises only 5% of new onset cases in Caucasian families and greater than 50% in Hispanic and African American ones. In about 50% of these cases, insulin can be gradually dispensed with after a number of weeks or months.

If your daughter does indeed have type 1A, the story of attempts to prolong this phase have been uniformly disappointing. Chromium as chromium picolinate is still used in type 2 diabetes, but has never been shown to be of value in type 1A. Nicotinamide in doses of 100mg/year of age/day in a slow release form alone and combined with another antioxidant like vitamin E likewise failed to prolong the honeymoon period. However, a study of schoolchildren in New Zealand did show that nicotinamide could delay insulin dependence for up to eight years in about 60% of high risk pre-diabetic subjects, and a large trial based in Britain called ENDIT is nearing the end of a similar study. Attempts are still being made to preserve the remaining beta cells after clinical diabetes develops with drugs like MMF (mycophenolate mofutil), but research emphasis is really moving to trying to better define high risk individuals and to treating them much earlier.

Islet cell transplant success was much advanced last year by a group in Edmonton, but prospects in children are still hindered by the lack of donors and by the present need for lifetime immunosuppression. The latter problem may be near solution with the discovery of techniques that can produce graft tolerance in a few days, and in the longer term, the hope is that surrogate insulin producing cells may be developed either from stem cells or by the bioengineering of other immunocompatible cells.

In meantime, new insulins and new ways of measuring blood sugar are doing much to make good control a little easier.

DOB