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July 27, 2000

Honeymoon

Question from Beaumont, Texas, USA:

My son just turned two and he was diagnosed with diabetes type 1 about two months ago. His diabetes team told us that he is slipping into his honeymoon stage at this point. His body is still making some insulin. Is there anything that we can do to prolong his honeymoon stage or even reverse the process and enable his body to rejuvenate these cells?

Answer:

About twenty years ago, there were a lot of studies on ‘prolonging the honeymoon period’. Mostly, they depended on antioxidants like nicotinamide and Vitamin E. They were unsuccessful, although, for a time, it seemed as though another immunosuppressive drug called cyclosporin was of value, but, in the end, this drug produced kidney damage. At this time, interest has shifted to the prediabetic where it has been shown that both nicotinamide and small doses of insulin can defer insulin dependence for many years.

As to restoring islet cell mass, the only way at the moment is through a transplant, a procedure that is not appropriate in a small child. There is much progress here though, and a New Zealand group is hoping to develop a technique that uses encapsulated pig cells that are protected from the autoimmune process. This would be an outpatient procedure and a relatively inexpensive one. It does not require immunosuppression but would almost certainly need to be repeated at intervals.

There are some other possibilities that are a long way in the future for humans but beginning to show promise in laboratory mice. So called ‘stem cells’ may be made to induce islet tissue, and ‘k’ cells which are part of the lining of the upper bowel have been shown to produce an insulin enhancing hormone after a meal. More importantly, they have been transfected with the insulin gene so that they produce insulin in response to a glucose load. Finally, there is a protein called INGAP which induces growth of islet tissue.

For the time being though, treatment is conventionally with insulin, but with new insulins like Humalog and glargine and even inhaled insulin, and, in addition, the development of essentially painless meters, achieving good control is gradually getting easier. Even two year olds have had success with insulin pumps. I’m sure your diabetic team will reassure you on these points.

DOB