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May 19, 2004

Diagnosis and Symptoms, Honeymoon

Question from Atlanta, Georgia, USA:

My five year old daughter was diagnosed with type 1 diabetes in January 2004 after taking her to the doctor for what I thought was a bladder infection and fever. Her blood sugar was 190 mg/dl [10.6 mmol/L] that morning, 45 minutes after a sugary breakfast. An hour later in the hospital her reading was 230 mg/dl [12.8 mmol/L]. Her A1c was 5.9. In the hospital for two days, they gave her between one-half a unit and one unit of Humalog after meals. Her blood sugar was normal at every check in the hospital. She went home with no insulin, and her blood sugar readings have been normal ever since (not one single high or low). She seems to be fine. It's been over four months now, and still no abnormal readings and no insulin. The doctor insists this is the honeymoon. What do you think?

Answer:

I really don’t know what answer is. From the things you said, I am not sure that your daughter has type 1 diabetes. It could be in the prediabetic phase, with the bladder infection contributing to a really early diagnosis. In this case, it is possible that your child will remain without insulin injections for a long time.

I recommend that she undergo some tests, i.e autoantibodies search (islet cell antibodies, GAD antibodies and IA2 antibodies), HLA typing for genetic susceptibility, an oral glucose tolerance test and an intravenous glucose tolerance test. With all the results from these tests, it will be easier to see if your child has type 1 diabetes (in the prediabetic phase or in the honeymoon period) or if it was only an exaggerated response of her body to an infection (sometimes during infection it is possible to see high blood glucose readings).

AS