My six year old daughter was diagnosed with type 1 diabetes four months ago. During this honeymoon phase, is the use of oral medications of any benefit to prolong this phase? I have been told no but I don’t understand why if her pancreas is still secreting some insulin. Also how important is an antibody test for diagnosis? This is not a routine test in this area.

The antibody test is not really necessary for a new onset diabetic in a Caucasian family. About 5% of this group are antibody negative and in these cases there is some prospect that they will cease to be insulin dependent after a number of weeks, though for how long is not known. In African American and Hispanic families however about 50% of new onset cases in children are antibody negative. The antibody test is of course important in judging whether siblings might be at risk and whether they might then be candidates for some form of preventive intervention like nicotinamide in the Canadian Trial CANENDIT.

There have been many attempts to prolong the honeymoon period and the only one that was successful for a time was the use of the drug cyclophosphamide. Unfortunately this was shown to produce kidney damage and so had to be discontinued. Nicotinamide and other antioxidants were tried and although these showed some success in delaying insulin dependance in ‘prediabetics’ there was no evidence that they prolonged the honeymoon period except in a group called LADA or Late Autoimmune Diabetes in Adults. A number of new immunomodulatory ideas are being tried out in those that are at high risk genetically and in children who are antibody positive but not insulin dependent; but in those that have become insulin dependent there is too little beta cell mass left to offer any prospect of relief.

DOB