March 4, 2006
Honeymoon, Insulin
Question from Wilmore, Kentucky, USA:
My 17 year old son was diagnosed type 1 five weeks ago. We changed doctors because the first one did not deal with kids. Yesterday, we met the new doctor. My son was on Levemir at night and Humalog before meals, using an insulin to carbohydrate ratio and correction formula. It seemed to be working well for him. The new doctor said my son is in remission and had us stop the Humalog, but keep the Levemir. We are still checking his blood sugars in the morning and before meals and sometimes at bedtime. This morning his blood sugar was 86 mg/dl [4.8 mmol/L]. Last night, his blood sugar was about 130 mg/dl [7.2 mmol/L]. We’re still counting carbohydrates and trying to not go overboard with the food. My son is a huge eater. He’s wiry and very active and, with his first regimen, seemed to be able to tolerate lots of carbohydrates, about 300 grams per day. We’re just kind of worried about making a change so soon and would like a little more information on the remission stage. I’ve been doing lots of research myself and the doctor talked to us about it as well. I want to know whether this is an appropriate management plan.
Answer:
During “remission,” I tend to keep the rapid-acting insulin (Humalog) and watch for any lows and then reduce the insulin to carbohydrate ratio. I don’t tend to suggest no rapid-acting insulin. I find patients then try to eat no carbohydrates and take no rapid-acting insulin, poor choices for growing children. I do understand the “remission,” but have made the choice to keep the program through it all. It seems easiest to just do it rather than trying to figure out when to start again. I, too, like to let the children eat to appetite, within reason.
LD
[Editor’s comment: This “remission” period is usually called the Honeymoon. For more information, see our previous questions about the Honeymoon.
BH]
