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August 4, 2003

Honeymoon

Question from Sutter, California, USA:

When my daughter was diagnosed with type 1 diabetes about five months ago, she was on three injections a day which were tapered off gradually as the numbers dictated. I gave her the last shot about three months ago, and her numbers have been 68-127 mg/dl [3.8-7.1 mmol/L] daily. We have a great doctor and support staff, but no one can tell me why she is not needing insulin now. I have asked to have her tested for the antibodies, but I was told to wait a few months. If the pancreas shut down and we did the injections, then stopped them, is her pancreas working now? Is it possible for this to happen? How long will it last? I don't understand, and I am not getting the answers I'm looking for, I guess.

Answer:

There are several possibilities that come to mind. The most likely is that you have induced an exceptional honeymoon. Often, the insulin doses can be tapered substantially, but only rarely have I taken someone with true type�1 diabetes off of insulin completely during the honeymoon.

As reassuring as the honeymoon is, it can be falsely reassuring if you don’t follow a meal plan and check glucose levels (or give insulin), given that you don’t know when the glucose levels could skyrocket and lead to DKA [diabetic ketoacidosis].

Your child could have type�1B or type�2 diabetes. The former is not as common at all and the latter is quite less likely in a child your daughter’s age.

Could the diagnosis of diabetes been wrong? Not all blood glucose elevation is due to diabetes; there are other (extremely rare) situations. I would proceed with antibody testing to help reassure everyone. I see no advantage in waiting.

DS