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March 9, 2004

Honeymoon, Research: Other Research

Question from Rapid City, South Dakota, USA:

I am a physician and my four year old son was diagnosed with diabetes yesterday. His only real sign was polyuria but his urinalayisis showed slight glycosuria so we did a fasting glucose the next day. His fasting glucose was 154 mg/dl [8.5 mmol/L], so it seems he has some islet cell function remaining. Today, his glucose levels were between 250 mg/dl [13.9 mmol/L] and 300 mg/dl {16.7 mmol/L] so we gave him a small dose of Lantus. His blood glucose level dropped to 180 mg/dl [10.0 mmol/L] in two hours. We would be willing to participate in clinical trials anywhere in the United States if significant prolongation of the honeymoon period could be expected. The islet cell antibody test results are still pending, but please answer the question assuming they will be positive.


I don’t think that there can be any doubt that your small son has diabetes and, if the family is of Caucasian descent, that he has TypeIA or Autoimmune Diabetes. A positive antibody test would certainly confirm this and that he is going to need some form of insulin supplementation for the rest of his life and would be of value to other children and future children in the family. It is perhaps worth adding that, if the islet cell antibody test that was done was just the immunofluorescent screening test, then a negative result does not exclude this form of diabetes and that it would be worthwhile repeating the tests for anti-GAD, anti-insulin and ICA512 and making sure that the tests are done by a laboratory that reports only as +ve or -ve, +ve meaning a level greater than 3SD above the normal mean.

As to clinical trials, there are still a number and they are encouraged by recent observations that new islets are still growing around the pancreatic ducts at a time that insulin dependence has begun, as well as the much older observations of still detectable serum C peptide levels. At the same time, the field recently had a major setback when two large national trials, DPT-1 of insulin vaccination and of nicotinamide, in Europe, were shown to be ineffective. At the present time, I think that the two most promising clinical trials are of Heat Shock Protein (DiaPep) which I believe is only in Israel (DNA vaccination with heat shock protein 60 inhibits cyclophosphamide-accelerated diabetes) and of anti-CD3 in this country in New York and at Stanford (Treatment of Type 1 diabetes with anti-CD3 monoclonal antibody: induction of immune regulation?).

Having said this, I rather wonder if the research protocols would admit a four year old and whether, too, the stress of neccessary travel and testing would justify the possible benefit. In the meantime, modern technology has much to offer to help achieve control, new insulins like Humalog and glargine, monitors that use minute and almost painless samples from the forearm, and the promise before long of infrared skin sensors for blood glucose that could one day be linked to a pump.

Additional comments from Dr. Stuart Brink:

There are no guarantees with any current clinical trials that the honeymoon would be prolonged. Early aggressive resetting of damaged beta cells is presumed to allow longer functioning, but this is also not entirely known scientifically either. It is reasonable and most, but not all, pediatric diabetologists try to accomplish this at onset of diabetes, if parent and child are willing to aim for such goals. You may want to contact the Barbara Davis Center in Denver since this is likely the nearest large research facility focusing on childhood diabetes and they could tell you about any possible intervention studies for which your child may be eligible.