October 23, 2006
Question from Staten Island, New York, USA:
My 17 year old son has had type 1 diabetes for 10 months now and uses an insulin pump with NovoLog insulin. His blood sugars have been excellent and the first two visits to the endocrinologist since diagnosis revealed an A1c of 5.8% with an acceptable number of hypoglycemic episodes…nothing too frequent. At the last visit, the endocrinologist figured out that my son was producing about 50% of his insulin requirement, based on how much NovoLog he is using daily, and was, therefore, in the honeymoon phase. My son is due for his third visit to the endocrinologist next week. The past couple of days his sugars have been quite high 150 to 238 mg/dl [8.3 to 13.2 mmol/L]. Does this sound as if he is coming out of the honeymoon phase? At the last visit, I asked the endocrinologist if excellent control is possible, i.e., an A1c of less than 6%, once a person leaves the honeymoon phase. The endocrinologist said it certainly is very possible, as long as a person is willing to increase the insulin dosage. Do you agree? Why can’t everyone maintain excellent control for life if they take their insulin, count carbohydrates and do what they are supposed to be doing? It has been so easy, so far, for my son. Will this continue once he stops honeymooning?
Once you need to replace all the insulin, it just isn’t as easy. The pancreas makes up for the extra insulin needed and is given at the right time. It just isn’t as easy to give the right amount when you have to give it all as shots, even with a pump. Balancing everything is just difficult. Also, it is hard to do it all day after day. Diabetes is a difficult disease. One has to admire patients who work so hard. One also has to understand how hard it is. I don’t mean to say it isn’t possible to have excellent control; I have many patients who do, but not all. The combination of diet exercise and insulin is presented in pretty cartoons. Balancing is presented in black and white terms. In truth, the same meal and the same insulin can give different readings. Why? The amount of exercise, the amount of stress that day or the day before come into play. Insulin isn’t absorbed exactly the same with each injection. Pump sites age or even fail. Insulin gets hot.
What I am trying to say is that you just plug along day after day doing your best. You accept the bumps and go on to the next part of the day and the days to come with good humor and continue to live a full and productive life with diabetes.