March 20, 2003
Daily Care, Diagnosis and Symptoms
Question from Clinton, South Carolina, USA:
My son has been labeled with type 1.5 diabetes by his diabetes specialist because he has the problems of both types. He has three of the antibodies for type 1.
The family doctor is saying he believes my son only needs pills at this time because the lab tests show he is making more than the required insulin levels (Insulin free 26.8: Insulin total 34.6). I had this test run three different times going without his medication for the required time, and it is always more. However, the specialist (who is known as the best in the area) has done nothing but try different combinations of pills and insulins for months, and all they keep talking about is putting him on the pump. We tried five types of insulin injections and pills and they would work for only a month. after about a month on insulin, his sugar levels go up to more than 300 mg/dl [16.7 mmol/L]. The pills we are trying now are controlling it great, but the specialist wants him on an insulin pump and keeps telling me that he is going through the honeymoon stage when I question him.
Can the honeymoon stage last for almost two and a half years? If he is getting worse, why are the lab levels so high? Isn’t the insulin pump suppose to be the treatment you go to when the others don’t work? Why are so many doctors pushing people into getting pumps?
Answer:
What you are describing doesn’t make much sense. If the antibodies are positive, then this is likely type�1 diabetes. If your son is also obese, then he may have something called insulin resistance which could sometimes be treated with the same type of medications (pills) as type�2 diabetes. Some researchers call this combination type 1.5. If the specialists are talking about an insulin pump, I would assume that glucose control is less than ideal with any of the combinations you have all tried so this would be the reason for suggesting a pump.
The questions you pose are excellent ones, and you need to get answers that make sense to all of you and are explained to all of you in great detail so that you can understand why such recommendations have been made. None of this sounds like a honeymoon or remission period since the blood glucose levels you describe are way too high. Go back to your diabetes team and perhaps arrange for a conference call with the diabetes team and your primary care physicians talking to each other so that both can be more consistent and understand the situation better — and give you and your family better advice.
SB
