My 42 year old husband was diagnosed with type 1 diabetes about three months ago. He is currently in his honeymoon period and is taking 13 units of Humalog Mix 75/25 with breakfast- and 13 units at dinner. His blood sugar is high in the afternoon after lunch/before dinner. It will run from about 170-200mg/dl [9.4 to 11.1 mmol/L]. This reading is several hours after lunch, and he is sticking to his meal plan. My husband also seems to feel unusually tired in the evenings. His endocrinologist seems to think that is okay and that since he is in his honeymoon period, he only needs two shots a day. We are not doing carbohydrate counting or mixing insulins because he feels that my husband is doing “just fine.” What is your opinion? Can’t blood sugars like this cause long term damage and also shorten his honeymoon period? Could his tiredness be a result of the high blood sugars?

A honeymoon period is thought to represent residual beta cells (the insulin-producing cells in the pancreas) being able to function and maintain the blood sugars at a near-normal level. However, some people refer to the honeymoon period is a time of decreased insulin requirements from original baseline conditions when the diagnosis was made and the sugars were higher.

Whatever the case, the sugars are still monitored and an attempt should be made to control the blood sugars well. General experience has shown that the better the blood sugar control during the honeymoon period, the longer the duration of the honeymoon period. I would use this general rule to address your husband’s situation. I feel I would be more aggressive with blood sugar control, wanting all pre-meal sugars less than 140mg/dl [7.8 mmol/L]. To do this, you may have to mix insulins to get a better custom regimen to meet your husband’s needs. This is especially true if his sugars are high in the afternoon but satisfactory prior to lunch. My own take on the commercially available insulin mixtures is that they are convenient but, you would not sacrifice efficacy for convenience in most situations, especially if you have no problems being able to mix the insulin components required.

The fatigue you are describing may be from high sugars, low sugars, or large swings in the sugars. More monitoring is required to identify the particular pattern occurring.

Finally, I feel now is probably a good time to learn carbohydrate counting. It is the single best means of matching insulin to the meal being eaten. It works well when is refined. It is also helpful as a day-to-day strategy for adjusting to variable meal content.

JTL