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December 21, 2006

Honeymoon, Hypoglycemia

Question from Australia:

I was diagnosed with diabetes at the end of September by a GTT. I've been in hospital with it twice since. The first time, my blood sugar went up to 24.4 mmol/L [439 mg/dl]. I was treated for DKA, but also told I had lactic acidosis (the only medication I was on at the time was Diamicron, but I quickly got worse.) I'm currently on NovoMix 30, four units pre-breakfast and pre-dinner and NovoRapid for high blood sugars only. I've been told that I'm type 1, in the honeymoon stage, and also that my diabetes was picked up in the very early stages. My diabetes has changed so much since it started. At the moment, my blood sugars are all over the place. For example, last week I woke up 7.2 mmol/L [130 mg/dl]. After breakfast, I was 4.8 mmol/L [86 mg/dl]. I was 3.1 mmol/L [56 mg/dl] before lunch last week and then 10.1 mmol/L [182 mg/dl] after lunch. A few days ago, I was 6.1 mmol/L [110 mg/dl] fasting and went up to 22.9 mmol/L [412 mg/dl] at the end of the day. After dinner, I took four units of NovoRapid and went down to 16 mmol/L [292 mg/dl] two hours later. Yesterday, I started at 7.1 mmol/L [126 mg/dl] and went up to 18 mmol/L [324 mg/dl]. Normally, my fasting blood sugars are between 4 mmol/L [72 mg/dl] and 7 mmol/L [126 mg/dl]. With having lows often, particularly in the morning after breakfast, I'm wondering whether I should come off NovoMix entirely for the time being. Some days, it's a real struggle to get my blood sugar above 5 mmol/L [90 mg/dl] and when I do (which is usually after lunch), my blood sugar will continue to rise during the day up until after dinner time when it is over 15 mmol/L [270 mg/dl]. Is that okay? Also, is it normal to have wide variations in one's blood sugar during the honeymoon period?

Answer:

It is not necessarily normal to have wide swings in your blood sugars during the honeymoon phase. The honeymoon phase is associated with functioning beta cells that can respond to your mealtime needs. The fact the blood sugars rise throughout the day suggests that you need additional insulin, but not at breakfast time. You might be better off not using a commercial form of mixed insulin. Rather, you can use more long-acting, and less short-acting, insulin in the morning. I would also recommend learning how to count carbohydrates so that you might be able to use a system of matching insulin for the food you eat. Please discuss these issues with your diabetes team.

JTL