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September 2, 2001

Honeymoon, Research: Cure

Question from Kingston, Ontario, Canada:

Our six year old daughter was just diagnosed with type 1 diabetes, her levels are coming down, and she might be entering the honeymoon phase. Is there anything we can do to prolong this stage? Are there any vitamins, supplements or medications we should try? Will there be a cure soon?

Answer:

You should discuss use of a vitamin B called nicotinamide with your daughter’s diabetes doctor. Several attempts to use this to prolong the honeymoon period have not been successful, although there is some evidence especially in a study in New Zealand school children that it may delay insulin dependence for some years, and there is a major unfinished trial of this in Europe called ENDIT. Keep in mind however the subjects in these trials are at an earlier stage of diabetes than your daughter. There are other trials underway using some of the newer immunomodulatory drugs in children who are already insulin dependent; but again, the results are not yet known. At this time, your best effort is to learn the intricacies of trying to maintain meticulous blood sugar control.

As to the prospect of a ‘cure’ — If by this you mean a complete restoration of the beta cells in the islets, I think this is very unlikely. Nonetheless, I believe that the near future will bring a number of technical advantages like non invasive monitoring of blood sugars and the ability to give insulin through the mucosa of the mouth. On a more permanent basis, though still some years away, is the possibility of giving encapsulated human or even porcine cells so that they secrete insulin appropriately; but are protected from rejection by the host’s immune system. This would be a simple outpatient procedure and would not need immunosuppression. Secondly, there have been at least two successful attempts by molecular geneticists to establish glucose sensitive insulin production in other cells in the body that are not vulnerable to immunosuppression. Finally, there was a report only this month of the first successful attempt to culture human stem cells so that they produced insulin. Most of this still some years off; but something to really hope for before your daughter goes to college.

DOB