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December 9, 2005

Honeymoon, Insulin

Question from Philadelphia, Pennsylvania, USA:

I am 27 years old. I was diagnosed with type 1 diabetes a little less than a year ago with a fasting blood sugar of 179 mg/dl [9.9 mmol/L] and an A1c of 8.4%. I have always been on a low dose of insulin, but have recently switched to pump therapy and have been using approximately only four units a day for my basal rate, with a sliding scale of 1 unit for 15 grams of carbohydrates for boluses. I recently began to experience lows and have realized that my blood sugar will stay around 115 mg/dl [6.4 mmol/.L] without any basal insulin at all and that a basal rate of 0.15 will keep me around 95 mg/dl [5.3 mmol/L]. In addition, although I had previously had high post meal blood sugars sometimes in the 200s mg/dl [11.1 to 16.6 mmol/L], I have not had a blood sugar over 150 mg/dl [8.3 mmol/L] for the last two weeks, even when eating large amounts of carbohydrates with reduced insulin dosages. My doctor has tested me for celiac and Addison's. Both sets of tests came back negative. Is it possible I am still honeymooning? What could explain the change to lower post meal numbers a year after being diagnosed?

Answer:

I cannot tell you exactly what is going on without more information. However, it sounds like you continue to make insulin. This is a good thing, as those who make insulin on their own have a much better chance of maintaining good blood sugar control. You can look at it that you have improved the glucose environment that the beta cells (the cells that make insulin) work in. That improves the efficiency of the remaining non-damaged cells. If you had not had such good control, you may not have had such good results with ability to make insulin. My bias would be to continue to control your sugars well and don’t let them drift up so high as to stress the remaining beta cells too much. Honeymooning is another term for having persistent insulin secretion. There have been reports of people maintaining some insulin secretion months to years after diagnosis when good glucose control is obtained.

JTL