My 35 month-old daughter was diagnosed with type 1 diabetes 10 months ago. About 2 months before diagnosis she had a very bad stomach flu. I have been told that this could have been the “trigger” which started the diabetes.

After diagnosis she had a very brief honeymoon period which lasted less than a month. She has since been on what I understand is a relatively low dose of insulin for her weight. About two weeks ago she had another flu and since recovery has jumped from 6.5 N and 2 H in the morning to 6.5N and 3 H. She is definitely not eating any more so I am wondering if the islet cell damage is complete now and whether there is any connection between this and the last virus she contracted. How long does complete pancreas shutdown usually take with type 1 diabetes? She is now 15 kg and taking 6.5 N and 3 H in the morning and 3N and 1.5H at dinner. What about growth spurts in children so young? Do these lead to temporary or permanent insulin requirements?

Surely the flu, as you said, and any other intercurrent illnesses could be a trigger for type 1 diabetes; a trigger, but not the cause of it. So instead of a flu it could be a parotitis or other viral infection. This trigger would have to work in a susceptible subject.

The honeymoon period could last a short or long time, and it depends upon many factors, but you can’t do much for it now that your child has an insulin requirement of about 0.90 U/kg/day. It is also normal have an increase in insulin requirement during a flu (as any other illnesses) because this can worsen glycemic control. Nevertheless, subsequent infections have a minor role in the complete destruction of insulin producing cells in the pancreas because this is a process that, once started, ends only with the complete destruction of those cells. The period during which there remains residual beta-cell function is called honeymoon period, and it lasts a different duration in each child.

Finally, about growth spurts in children, many researchers have not found any difference between diabetic children and non-diabetic ones, when glycemic control is satisfactory. So I think you don’t have to be worried about your child.

AS