April 18, 2001
Honeymoon
Question from Pennsylvania, USA:
I am in the medical profession, and, about a month ago, my 14 year old daughter was diagnosed with type 1 diabetes after a viral episode and three days of polydipsia [excessive thirst]. Her fasting blood sugar was 290 mg/dl [16.1 mmol/L], her hemoglobin A1c was 7.7%, and she had no ketones. I began her on intensive insulin therapy of four injections per day (Regular at meals and NPH at bedtime). She had control without any excursions after two weeks and at week three was in a honeymoon. I maintained giving her 1-2 units of NPH in the morning as was recommended. Her glucose monitoring reflects a 14 day control of 110 mg/dl [6.1 mmol/L]. This is now week five, and she does not need insulin. How long can we expect on average for the honeymoon to last? islet cell antibodies, ICC, and GAD 65 are pending. My younger brother was also diagnosed with type 1 at age 30. What are the occurrences of transient hyperglycemia? Could some of her beta cells survive if it was not autoimmune?
Answer:
This does sound like type 1A (autoimmune) diabetes, and you picked it up pretty quickly. There is some evidence that those who don’t go into DKA [diabetic ketoacidosis] have a longer honeymoon period, but it is weak. Although honeymoon periods are of variable length, I know of no other predictors of duration. It does seem biologically plausible, however, for any remaining islet cells to fare better if the prevailing blood sugars are normal.
KJR
