May 13, 2007
Diagnosis and Symptoms, Honeymoon
Question from West Midlands, United Kingdom:
My daughter was diagnosed with type 1 diabetes in March 2007 after we went for a routine private medical for immigration purposes. When she was admitted to the hospital, her blood sugar was 19 mmol/L [342 mg/dl]. She was started on seven units of Mixtard 30 before breakfast. Since then, we have had to gradually lower her insulin dose due to her having one to two hypoglycemic reactions a day, as low as 1.6 mmol/L [29 mg/dl], but always under 4 mmol/L [72 mg/dl]. We have been told that we may have to stop her insulin injections and just see what happens with her blood sugars as when she wakes in the morning, she has an average blood sugar of 4.5 mmol/L [81 mg/dl] to 7.5 mmol/L [135 mg/dl] and they are unsure as to wether she is type 1 at all. MODY has been mentioned to us, but I am confused about what to think. Could this be the honeymoon period? The last week, she has had a sore throat and has gone as high as 26 mmol/L [468 mg/dl], but no ketones have ever been present. We are at the hospital next week and would like some advise before I see the doctor.
Answer:
I really cannot answer such questions without a lot more information. You need to ask about islet cell and GAD-65 antibody test results. If positive, then she has type 1 diabetes. If negative, this won’t resolve the issue since the tests are not perfect. Most pediatric diabetologists do not recommend the mixed insulins that you have mentioned since they provide no flexibility. Most use a basal-bolus multi-dose regimen with one of the fast analogs (Humalog or NovoRapid) before meals with Lantus or detemir as basal insulins once or twice a day. But, all should be done on the basis of frequent daily blood glucose readings, carbohydrate counting or other meal plans. If this is a honeymoon period then, obviously, the doses of insulin should be decreased, but most of us rarely completely stop insulin treatment.
SB
