December 11, 2002
Daily Care, Diagnosis and Symptoms
Question from San Luis Obispo, California, USA:
I am a 21 year old female (5 feet 6 inches, 125 pounds), diagnosed about seven months ago with type�1 diabetes. I had all the classic symptoms, a fasting blood glucose of 696 mg/dl [38.7 mmol/L], and an A1c of 10.3%. Initially, I was treated with NPH and NovoLog, but I had a problem my blood glucose dropping every afternoon and overnight, so I went on an insulin pump.
After three months, my A1c was down to 5.7%, but I was believe to be in my honeymoon period, and shortly thereafter, I went to Europe where my skyrocketed to the 300s mg/dl [16.7 mmol/L], no matter how much I raised my insulin. When I got back to the USA, I called my endocrinologist who told me to keep raising my basal and determined my honeymoon was over. Six months after diagnosis, my A1c was 6.1, but my numbers were jumping all over the board in any given day, and I am having a really hard time keeping my numbers in the target range.
I talked to my doctor about this, and she had me do several fasting tests to ensure my basal rate was set correctly. However, each time I tried to fast, my blood sugar would go low. I told my doctor about this and she said try lowering my basal rate and trying again. I did this, but I still went low. Eventually it got to the point where I could detach from my pump and take no insulin for 14 hours at night time. I did this for five nights, each night I went to bed high and woke up in the normal range. I told my doctor about this who said to try it during the daytime. I did this, and I stayed normal accept when I ate. Could it be that my body just needs more insulin at meal times? All this testing was interrupted by my period which always makes my sugars higher. One thing is for certain though. If I fast (or carb fast) my sugars are normal, and it seems clear that my honeymoon ended.
My doctor had me do the C-peptide and antibody tests last week. She says it will take one more week to get the results back. Until then, I’m stuck with poor control no matter how hard I try. I test my blood glucose 10-14 times a day because my numbers are jumping all over the place, and I feel crappy all the time. Is it possible to have two honeymoons? Does this sound like a form of Maturity Onset Diabetes of the Young MODY? Do you have any ideas? Do you think going on an oral agent could be beneficial?
Answer:
I would have to say that I agree with what your physician is doing. You are not in total meltdown as your hemoglobin A1c is still 6.1%. What you are experiencing is the difficulty of replacing insulin when you make less than you should in response to a meal challenge. It is an imprecise technique. However, I agree that the series of fastings used to check the basal rate is appropriate, and something I think is very important. Your physician is also going about checking tests that differentiate type 1 from type 2 diabetes. I would wait for these tests to come back before planning additional therapy. Oral hypoglycemic agents are reserved for type�2 diabetes. If you do not have type 2 diabetes, this is not an issue for you.
I empathize with you regarding your frequent fluctuations in your glucose levels. I know it doesn’t feel great. Give your physician a chance. One thing I do ask is that monitoring be performed and reported intermittently. Maybe you can do something like that to better adjust your insulin delivery.
JTL
