I have a daughter that just turned 4 years old. She has been a diabetic for almost a year. She never went into a honeymoon phase, and her doctor keeps telling me that she never will. From what I have read, all of the children go into the honeymoon phase. I’m trying to figure out why my daughter didn’t go into a honeymoon. Her blood sugar levels are all over the place and she is an unpredictable eater. I want to change her insulin around and her doctor forbids me to do it. She is on Humalog for breakfast, lunch, 3 P.M. snack, supper and a mixture of Humalog and Lente Pork at bedtime. I want to give her Lente L Pork at lunch instead of the Humalog and not give her the 3 P.M. insulin.

Honeymoons do not always occur so your child is not so unusual. The younger the child, the less likely the honeymoon to occur.

It sounds like your daughter has typical child-onset glucose levels with lots of unpredictability. It also sounds like you are intensively monitoring and making insulin adjustments. You didn’t say what her hemoglobin A1c levels were since this would give you some feedback about how you are actually doing — even though there is much day-to-day variation. Diabetes treatment is extremely difficult in such circumstances but you shouldn’t get overly discouraged.

If your pediatric diabetes consultant has a different approach from you, you need to go back and spend some quiet time at the end of the day in consultation — so that you can explain your position and hear his/her position. Perhaps your nurse educator or dietitian can be of some help to get this done. We have many people using a system just as you describe with overlapping doses of NPH three or four times a day to try to balance out basal insulin needs, quite successfully. There is also a new insulin called glargine about to be released that may solve this problem as well. Problem solving based upon actual blood glucose readings and pattern identification certainly makes sense to me so you may merely need to discuss things in more detail with your diabetologist in order to try it out and see if it works or not.

SB