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February 9, 2007

Honeymoon, Hyperglycemia and DKA

Question from Lower Burrel, Pennsylvania, USA:

I am trying to understand how growth hormones affect glucose levels. My daughter was diagnosed with type 1 diabetes on April 20, 2006. She has been doing reasonably well, with her last A1c at 7.0. At present, she is on about five units Humalog, one and a half units of NPH per day. Her glucose readings last week are generally around 70 mg/dl [3.9 mmol/L] to 170 mg/dl [9.4 mmol/L]. But, for the past three or four days, she has jumped up well over 200 mg/dl [11.1 mmol/L] at dinner, way above the norms of the week before. And, today, she was 98 mg/dl [5.5 mmol/L] before breakfast. She got four units of Humalog, no NPH. At school, at lunch time, she at 337 mg/dl [18.7 mmol/L]. She only had a small mid-morning snack as usual, certainly not enough to crank her up to over 330 mg/dl [18.3 mmol/L]. She is not sick and nothing in the diet has changed. Is this a typical symptom of growth hormones kicking in and out ?

Answer:

No, I don’t think growth hormones might be responsible for blood glucose fluctuations. Instead, you are probably seeing the waning of the initial, and only transitory, honeymoon period. Also, you may wish to discuss a different insulin regimen with your daughter’s diabetes team. You could probably achieve better metabolic control using Humalog and glargine (Lantus), a non-peaking long-acting insulin.

MS

[Editor’s comment: Please see our previous questions about the Honeymoon period.

BH]