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August 5, 2004

Diagnosis and Symptoms, Honeymoon

Question from Avon, New York, USA:

My husband is 27 years old and was recently diagnosed with type 1 diabetes. He was admitted into the hospital with a blood glucose of 585 mg/dl [32.5 mmol/L]. His doctor ordered him to be on a sliding scale of Humalog before meals and Lantus at bedtime. His blood glucoses have been totally normal for several weeks without any insulin at all. He even stopped Lantus at night and his blood glucoses have been perfect. We have been paying extra attention to his dietary intake. Is it possible he had/has another condition that may have caused the hyperglycemia? He was diagnosed on July 1, 2004 and his A1c was 12 at that time, but hasn't been redrawn yet. I am a nurse, but feel very inadequate in this area. I'm not convinced he has diabetes, especially since his pancreas must be producing some insulin in order for his blood glucoses to be so low without insulin.

Answer:

It sounds like your husband is going through a phase where he doesn’t require any exogenous insulin. This corresponds to a recovery by the pancreas where the surviving beta cells are making insulin in an environment where the high sugars have been taken away. This is called the honeymoon period. It is fairly common in type 1 diabetes to have this period of time where very little to no insulin is required for treatment. The scope of autoimmune diabetes begins years before clinical diabetes so that only 20 to 30 percent of the beta cells have survived. The only problem is that the same autoimmune process eventually destroys the remaining beta cells. The honeymoon phase can be optimally prolonged by attention to lifestyle issues, such as diet and exercise, and the maintenance of normal glucose levels. Type 2 diabetes is a possibility, but this usually occurs in people who are obese, have a family history, and who have measurable insulin still present. There are additional markers of autoimmune diabetes, including antibody levels for anti-GAD antibody, anti-islet cell antibody, and anti-insulin antibody. I would discuss these with your physician to make sure you and your husband feel his diagnosis is accurate.

JTL