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February 22, 2005

Honeymoon

Question from Grand Rapids, Michigan, USA:

My son, who is now seven and a half years old, was diagnosed with type 1 diabetes in July 2003. He had no symptoms at the time. Sugar was detected in his urine during a routine physical, but no ketones. At diagnosis, his fasting blood sugars were 118 and 130 mg/dl [6.6 and 7.2 mmol/L]. His A1c was 7.9%, C-peptide was 1.2 ng/L, and GAD65 Ab was 0.01 nmol/L. One year later, his C-peptide was 0.7 ng/L (neither fasting or stressed) and his GAD65 Ab was 0.0 nmol/L. After 20 months, his weight is 58 pounds, his total daily dose of insulin is about 12 units land his A1c is 5.5%. We are doing well and he seems easy to control. He has never had ketones and I have ony seen his blood sugar reach 300 mg/dl [16.7 mmol/L] on three occasions. His doctor seems to wonder if he has something other than the usual type 1. There is no doubt that he needs the insulin, but I am curious, too. Could he just be having a long honeymoon? He has no relatives with type 1 that we know of.

Answer:

It is possible this is not a classical type 1, although with positive antibodies, it seems more likely that his diagnosis was made early and he has a prolonged honeymoon. There are some special research tests for other types of diabetes that your diabetologist may be able to access but following closely his blood sugar readings and using insulin to help keep his blood sugars as close to normal as possible without excessive or severe hypoglycemia seems a good course and very practical. Time will let you know if this is going to change, particularly in adolescent years when other pubertal hormones “kick in.”

SB