December 27, 2001
Question from Franklin, Massachusetts, USA:
My seven year old son, who has had type 1 diabetes since age three and a half, has had relatively good hemoglobin A1c results and lately his daily numbers are much improved. In the past six weeks, he has had several instances in which he has had far more food than his insulin injections should have covered (and he has not been exercising), yet his numbers have been low in these cases (below 80 mg/dl [4.4 mmol/L]). Today he had more food than usual for breakfast and less insulin than he usually does and he was low by 9:15 am.
Is it at all possible for a child’s body to be once again producing some insulin after almost four years of diabetes in which it seemed he was producing none? How long does a honeymoon last? Are there any cases of a spontaneous remission from type 1 diabetes?
I have to say at the outset that spontaneous remission does not happen, although there are occasional children who continue to produce some insulin on a long term basis. However, I would have to confess to being somewhat suspicious that your son is manipulating his insulin to be able to eat more. It is also important to bring the recent changes to the attention of your son’s diabetes team because he should be checked out for associated (but rare) conditions such as coeliac disease, hypothyroidism, and Addison’s disease, all of which can result in unexplained reduction in insulin requirement.