April 12, 2016
Diagnosis and Symptoms, Honeymoon
Question from Elburn, Illinois, USA:
My son was diagnosed in August 2015 with a fasting blood glucose of 247 mg/dl [13.7 mmol/L] and trace ketones. He tested negative for all autoimmune markers, but low on C-peptide. His carbohydrate to insulin ratio was 1:60 a month after diagnosis. Lantus was two units nightly. Average insulin per meal was 0.5 unit. His A1c was 5.9 in October, 5.7 in January. He was low a lot and needed a lot of juice boxes, glucose tabs and food. As of February 2, he was receiving no insulin for meals and 1 unit of Lantus and was still low all the time. On March 3, his A1c was 5.1 and a re-test of C-peptide was 1.18. Becasue of all the lows, we stopping giving him Lantus. I was told he is now honeymooning. The doctor’s office said to stop using the sensor, check his blood sugar in the morning and periodically after high carbohydrate meals. I am now confused because I was taught to check and count carbohydrates regularly, the opposite of what I am now being asked to do. Please tell me your thoughts.
Antibody negativity occurs about 15 to 20% of the time but this may need to be repeated to be sure that it really is negative. If so, he could just be one of that group without positive antibodies or could have a different type of diabetes rather than classical type 1 autoimmune diabetes. If so, that may explain the very low insulin requirement initially and now “no insulin” requirement. I would continue to monitor him and continue to count carbohydrates and maintain consistency, optimal weight, etc., as well as continue to watch blood sugar levels to see if they change. Sometimes there is a long honeymoon phase but we do not quite know how to explain these differences, only that we see them. Time is the best guide as to what you will need to do because if the blood sugars remain closely monitored and normal pre- and postprandial (before and after meals), then just watching the food and weight and activity is all the “treatment” that he needs. If this changes, as long as you are watching his results, if and when the blood sugars rise, the insulin can be restarted without any risks. It is especially important to watch blood sugars during growth spurs and puberty changes as well as during intercurrent (usually viral) illnesses since those are times that more insulin is needed. If he cannot make the needed insulin on his own, then his sugar levels will rise.