My daughter was diagnosed with type 1 diabetes two and a half years ago. She is now ten years old. She is using an insulin pump and averages about 12 units of NovoLog a day. I have been told that this is an extremely small amount of insulin. Is she still in the honeymoon stage. If so, how long can it last?

You should ask this question to your diabetes team since they would know your child well enough to be able to give you an educated guess. The smaller the amount of insulin needed, the more likely that there is some other source of insulin, i.e. her own pancreas. The more labile the daily blood glucose values, the less likely the pancreas is still making any significant insulin. Insulin dose also varies considerably, but there are some general rules based upon weight. Usual doses for children, prepubertally, are in the 0.5-0.9 units/kilogram body weight/day. In puberty this can go up to 1.5 or sometimes even higher for several months or a few years. After puberty, when growth hormones and other hormones “quiet down, ” then the dose also decreases significantly and overall glucose control is easier to sustain. There is a research test, called C-peptide, that estimates insulin available from the pancreas but it is expensive and usually not of much use except as part of a research protocol. Who really cares about the exact length of a honeymoon phase since the real goal is glucose control and not how much or how little insulin is needed, except for academic and intellectual discussions?

SB