May 29, 2005
Diagnosis and Symptoms, Research: Cure
Question from Los Angeles, California, USA:
I’m a 43 year old man, diagnosed with type 1 diabetes one and a half years ago. My blood sugar was 375 mg/dl [20.9 mmol/L], I had ketones, and I’d lost 15 pounds in three weeks. My first doctor had me on the NovoLog/Humulin cocktail before breakfast dinner and I experienced many “lows”. My new endocrinologist switched me to 12 units of Lantus with one or two units of Humalog before each meal.
After some low results, I’m now on six units of Lantus at night, with no Humalog before meals. My numbers have stayed good. I always wake up at 105 mg/dl [5.8 mmol/L] and my diet has been lower carbohydrate, etc. My 30 day average is 122 mg/dl [6.8 mmol/L] and once in a while I’ll shoot up to 180 to 200 mg/dl [10.0 to 11.1 mmol/L]. I notice that, if I try ice cream ( I do avoid sweets), I’ll shoot up to 220 mg/dl [12.2 mmol/L], so I know I still don’t produce enough insulin on my own.
My endocrinologist says I’m producing some of my own insulin and doesn’t think this is a honeymoon. He’s not sure why, but maybe because the “recovery” has been more of a gradual upswing. My A1cs for the last year have all been in the 4s. He says I may be recovering and wants to see how I do in next few weeks before taking me off of the Lantus and, subsequently, no insulin whatsoever.
Though very improbable, are there cases of even one person getting better? What about my case?
Answer:
When patients are diagnosed with type 1 diabetes, a significant number of beta cells (the insulin-producing cells in the pancreas) have been destroyed by the autoimmune process. This may range from 50 to 80%. The process would have initiated itself months to years before diagnosis. However, when it was diagnosed, and insulin therapy initiated, there is improvement in the function of the remaining beta cells. There can be enough improvement to allow for the discontinuation of insulin therapy.
Unfortunately, this period of insulin independence does not last indefinitely. Within weeks to months, the same process that destroyed the original cells will destroy the remaining cells. There are now clinical trials looking at trying to treat patients with medications that stall any further destruction of the remaining beta cells. You may want to check with your physician to see where those are being conducted in Los Angeles. The duration of this period of insulin independence is related to how well the sugars remain. Therefore, there remains a thought that some insulin to control blood sugars may be warranted. This remains an alternative to no insulin but with high intermittent sugars.
JTL
