June 1, 2005
Diagnosis and Symptoms
Question from Portland, Oregon, USA:
A recent question was asked about whether or not a young child could still be in his honeymoon after almost three years. I was confused by the answer. The answer was, “I don’t know if your child could still be in his honeymoon period or if his diabetes is not autoimmune one (type 1 diabetes) but a genetic form that could start early in life. Did the doctor check for autoantibodies at onset?”
My son is four and was diagnosed two and a half years ago. His doctor told me on our last visit that he was still in his honeymoon because of the low levels of insulin he is on. He is 38 pounds and takes two units of Humalog and 5 units of NPH in the morning, about one-half a unit of Humalog and one-half a unit of NPH in the evening. He consumes about 150 grams of carbohydrates throughout the day, 50 of them at breakfast. His A1cs have been between 6.8 and 7.2. His father has celiac disease.
What is this genetic form and how would I know if my child falls into this category? And, why would the genetic form require less insulin that the autoimmune type? Should I talk to my doctor about this?
Answer:
It sounds like your child is using typical amounts of insulin for a preschooler. There are, however, wide variations of insulin need and some of this reflects how much residual insulin is still available. The best clinical way to think about insulin needs is on a weight basis. Day to day blood glucose variability is also a good way to think about how much of his or her own insulin is still available and how the entire pancreas responds to day to day food, activity and illness variables as well as growth variables. All these affect blood glucose readings and insulin needs. Unless in a research study, there is not much helpful information from antibody testing or genetic testing or C-peptide testing that cannot more easily and less expensively be obtained from frequent blood glucose analysis with an experienced pediatric diabetes team. Most of us also test periodically for thyroid antibodies and thyroid functions (i.e. TSH) and also for transglutaminase antibodies for subclinical but important celiac disease.
SB
