June 15, 2005
Honeymoon, Hyperglycemia and DKA
Question from New Jersey, USA:
I have a four year old son that is on 1.5 units of Lantus at night and on a scale starting from one unit of NovoLog for breakfast and dinner and one unit of NPH in the morning. He was diagnosed on December 26, 2004 last year.
My questions are:
Is it possible, without any extra food, that the level of blood sugar will rise four hours after a meal? Last week, we went for a long stroll. At noon he had a reading of 215 mg/dl [11.9 mmol/L]. We administered his insulin and at 3 p.m., he was 260 mg/dl [14.4 mmol/L]. Then, without any food, at 5 p.m., he was 310 mg/dl [17.2 mmol/L]. I first thought it was related to the activity, but it happened one night again. At 3 p.m. he was 160 mg/dl [8.9 mmol/L] and in the morning he was 215 mg/dl [11.9 mmol/L]. I always thought that in order for the liver to use the sugar reserves, the blood sugar has to be low, but my son had no lows.
If he had all antibodies negative, would any of the proposed vaccines (Diamyd, Diaprep, etc.) work on him?
He usually has a good control. About 75% of his blood sugars are between 100 and 200 mg/dl [5.6 and 11.1 mmol/L], but sometimes, like last week, his numbers would go up for three days with no apparent reason. Eventually, the numbers would be under control, although my son’s insulin needs have been raised by half of a unit. Could this be triggered by allergies, since he does not seem sick at all? Could the numbers go up because he is coming out of the honeymoon? I presume he is still in his honeymoon, as at 20 kg (44 pounds), he takes an average of six units of insulin a day. Until recently, he was on four units.
Because he was on very little insulin, his nutritionist said it was too early to start on a carbohydrate to insulin ratio. Do you think, with his increased insulin needs, that now would be a good time?
If any of the illnesses would push him little by little out of the honeymoon, do you know of any method, besides keeping him in a sterile environment, that would preserve his pancreatic function?
What do you think would come first: a cure for diabetes or a preventive vaccine?
Answer:
Here some possible answers to your list of questions:
Blood sugar levels may rise three to four hours after meals after the weaning of fast insulin given at meals if the basal insulin (glargine or NPH more often) doesn’t cover properly the between meal intervals and/or the nighttime period especially around dawn. Physical activity paradoxically may worsen this rise with blood sugar levels higher at fasting than at bedtime the evening before;
I don’t think so;
It might be the honeymoon, allergies are very unlikely to influence metabolic control;
You should always use the carbohydrate to insulin ratio
Try to keep him on the best metabolic control in order to preserve his endogenous insulin production for the longest time;
A preventive approach might come first, but we’d need to pinpoint the true etiological factor that trigger the disease.
MS
