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December 16, 2007

Honeymoon

Question from Powder Springs, Georgia, USA:

My child just had her third year anniversary. She has been on a pump for almost two years and her A1c ranges between 5.7 to 6.3. She still takes very little insulin. Her basal rates, which I change often, range between 3.5 to 4.0 units a day and boluses range between eight to 11 units a day. She weighs 38 pounds. I asked my doctor if she is still "honeymooning" (although since diagnoses I have never considered it a honeymoon since her blood sugars are very hard to control) and he said that she still takes very little insulin. What should I expect when she is no longer "honeymooning?" Will I know when the honeymoon is over? She can go through weeks at 3.5 units of basal insulin per day and then we need to increase them for a couple of weeks because her blood sugars are constantly high. The blood sugar stabilizes for a while and then her blood sugars start to go low so we decrease the basals for a couple of weeks until her blood sugars stabilizes. She is not sick during the increases or under different type of stress. Is this common?

Answer:

You describe a very unusual situation but, in a very small child, sometimes this is seen. It sounds like your A1c results are terrific even though there are lots of ups and downs on a daily basis. The pump should help but it is not perfect. There is no true definition of the honeymoon phase nor its ending. From the description of your blood sugar results, she is not likely in a honeymoon. A1c values do not count nor do total insulin doses particularly when used in a very small child where the total insulin dose is small as well. One could check pancreatic insulin reserves with a C-Peptide test, but this is mostly a research tool. If elevated, this would mean some of her own insulin is still available even if not at correct times. If negative, this would mean that none of her own insulin remains available and sometimes this is used as part of a definition of the honeymoon phase.

SB