February 12, 2000
Honeymoon, Thyroid
Question from North Carolina, USA:
My daughter is 11 years old and was diagnosed 14 months ago. She had been experiencing what I would now consider lows for several months prior. (She would all of a sudden demand food, that instant, fine one minute and starving the next! I thought maybe there was an attitude problem.) Once I even put her off, and she ended up vomiting when she got food. Also, I recall once her claiming to see spots, but I put it off on the heat, and playing hard, plus had had a headache. We took her to the doctor for a yeast infection (had also wet the bed twice the week before, which was a rarity, but I was out of the country, so I figured she was upset about that. She didn’t want me to leave.) Her blood glucose was 465, and A1c was 10.6. However, her blood sugars have been very controllable. Every now and then difficult, when not feeling well. She has even been off insulin at times. Actually have had many 30-40’s. Never passed out, she is very aware of her body. She is currently taking 15 NPH in the A.M.and 3 NPH at bedtime. We use a sliding scale for Humalog. Seldom do we have to use Humalog, however when we do it is usually a couple of times in the same day, or over a period of 2-3 days.
How long could the honeymoon stage continue? How will puberty affect it? Is in not unusual for the honeymoon stage to continue so long? Her A1c’s have all been between 6.8-7.3. Will it be a gradual rise or just suddenly change? Also, can this stunt her growth? She was always one about 85 percentile for height and 70 percentile for weight. She doesn’t seem to have grown much in the past 2 years. Her sister who is 2 years younger weighs 73 and she weighs 75, about 3-4 inches difference.
Last but not least, how long could she have possibly had it, before she was diagnosed? We were somewhat suspicious the year before at here check up and made sure they checked, but it did not show. Is it possible her blood glucose were just normal that day? Some of those symptoms I mentioned earlier were present then.
Answer:
There are some aspects of the history of your elder daughter that I think you should discuss with her doctor. The first is whether she had an antibody test at the time of first diagnosis. If she had and it was positive then she clearly has Type�1A (autoimmune) diabetes and the honeymoon period of 14 months is rather uncommon; but sometimes it can be as long as two years. The autoimmune process was almost certainly present since early childhood. Her insulin requirements are about half the normal amount for her weight and they may gradually rise to normal over several months or quite abruptly if she gets some infection this winter.
More importantly, she does seem to have shown some growth failure. Although still at the 25th percentile for weight she is behind her sister and hasn’t grown since becoming diabetic. I don’t think this can be ascribed to the diabetes as her control seems to have been rather good and in the circumstances I would certainly ask about a TSH test for hypothyroidism which is another autoimmune condition commonly associated with Type 1A Diabetes. Finally it is possible that your daughter in fact has what is now called Type�1B diabetes. This presents in exactly the same way as the autoimmune variety; but after a number of months about half of them are able to come off insulin and be managed on oral medication or even with exercise and diet. This form is rather uncommon in Caucasians however although it constitutes just over 50% of new onset cases in Latinos and African Americans.
Puberty may make the diabetes rather harder to control, this is usually ascribed to hormonal changes; but I must say I’ve always thought that teenage psychosocial problems are the real problem.
DOB
