February 10, 2002
Diagnosis and Symptoms
Question from Charlotte, North Carolina, USA:
My 12 year old daughter was diagnosed with type 1 diabetes, which we happened to stumble upon during a sports physical. I insisted on putting her on a strict carb diet for a week then repeating her fasting blood sugar which was 109 mg/dl [6.1 mmol/L]. So, she went back to eating normally, and because it was close to the holidays, she was eating extra “junk food”. I started noticing she was having to use the bathroom more often and was getting quite thirsty. This happened for a few days so I called the doctor for a glucose test. which was 264 mg/dl [14.7 mmol/L]! She went straight to the hospital and was only there for 21 hours.
My daughter is eating her veggies, meat, and breads, but is staying away from sugar. She is watching her carbs (mostly the sugary kind — junk food), and I understand that it’s important that she maintain a good carb intake because she is still growing. Currently, the diabetes team has her on 1 unit of Novolog per 30 grams of carb Novolog before meals with 9 units of Lantus at night, but even on these doses, she still is having lows every day!
I understand the “honeymoon” stage varies and can last from a few months to years. Is it possible that because we found out about her diabetes so early, and she had no other symptoms, that we have a slight chance she may recover if she gets on a strict diet?
Hopefully, “one day” there will be a cure for diabetes, but until there is, I’m very thankful for the doctors and the research being done. My daughter is excited about the pump, and because her doctor started her immediately on the Lantus and Novolog, she will be really ready for the pump!
Answer:
I do not think that you should expect a reversal or recovery of her diabetes. The honeymoon often can be dramatic, but it is a fine line to walk: if you take away too much insulin, her own pancreas has to work harder and the honeymoon tends not to last as long. So in typical type�1A (autoimmune) diabetes, I would not want to take away too much insulin. In type�1B diabetes, sometimes we see that insulin may not be required for longer periods, but it is always, eventually required. By chance do you know if she had pancreatic antibody testing? If the results showed positive GAD 65, ICA 512, or insulin autoantibodies, this would be more consistent with typical type�1A (autoimmune) diabetes.
However, your observations are first rate. This is the basis of use of the glycemic index in meal planning that many folks rave about, and i they are also relative to the high protein, low carb diets. Are they realistic for a child to follow? Probably not. Are they harmful? Maybe not, but the increased protein load causes the kidneys to “work harder” which may be problematic.
I think you should have some practical discussions about diet options not only with your daughter’s diabetes doctor, but also the dietitian who works with the doctor.
DS
