My niece, almost three years old, was recently diagnosed with type 1 diabetes. She lives in South America. She almost went in to a diabetic coma at the beginning and, after two months, her doctors and parents finally stabilized her between 80 to 120 mg/dl [4.4 to 6.7 mmol/L], but recently, in the last week, she has been 120 to 250 mg/dl [6.7 to 13.9 mmol/L]. First, these higher readings were in the mornings, but now they are also at night. They did not make any change in diet or exercise routine.The doctor is telling them to wait, but we need a second opinion.

Your niece is likely in a rather delicate stage of diabetes that is common and often referred to as the “honeymoon phase.” In this condition, the pancreas gets a “second wind” of sorts and begins to produce insulin a little better. Why? No one is completely certain, but a common explanation is that while the child has been receiving extra insulin by injection, the child’s pancreas has had time to “rest” and heal some and, thus, get a slight renewal in the insulin producing capacity.

ALL DIABETIC HONEYMOONS END. Typically, they last about a year or so, but I have seen them end much sooner. It appears that while the child is in this “honeymoon, ” the diabetes is so much easier to control and even when the meal plan is not followed best or the child’s activities are not so predictable, the glucose levels do pretty well as the child’s own pancreas “makes up the difference” by secreting more insulin. Perhaps a better description of it would be: it’s the last gasp of insulin. During the honeymoon, sometimes families are actually able to taper away some of the insulin from the injections, because otherwise the child gets too many episodes of too low glucose readings (hypoglycemia).

Sometimes, I think that what happens is that during the honeymoon, things are going surprisingly well to the parents so they get a bit lax in following the meal plan or exercise/activity plans. Then, when the honeymoon ends, they ask the same question as you: “We’re not doing anything different! Why are sugars higher?” The answer is that indeed you are NOT doing anything different. The status of the diabetes has changed. Perhaps you NEED to do something different.

While your niece’s physician may wish to watch for a bit (and that is not unreasonable as an intercurrent illness could lead to some higher glucose readings), if the higher sugars persist or progress, the family should discuss options to increase insulin or change the meal and activity schedules.

DS