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March 1, 2005

Honeymoon, Insulin

Question from Friendswood, Texas, USA:

My seven year old son was diagnosed with type 1 diabetes on January 4, 2005. He had a glucose reading of 450 mg/dl [25 mmol/L] and an A1c level of 9.8%, but a C-peptide (CPEP) reading of 1.2 ng/ml. My son was immediately started on an insulin regimen. Since diagnosis, I have consistently reduced medication and carbohydrates to the point where he is now receiving 1.5 units of Humulin NPH in the morning one hour before breakfast and 2.0 units of Humulin NPH one hour before dinner. His blood sugar levels are now consistently at or below 100 mg/dl [5.6 mmol/L] and his A1c test is now 7.3%. Is it possible that my son is type 2 diabetic, or am I deceived by the C-peptide measurement and he's only now in the "honeymoon" period of his condition? Are there additional test that can be done?

Answer:

Please see similar questions on the Honeymoon.

If your son presented with increased urination, increased thirst, a degree of weight loss and the above glucose levels and had ketones present, he has type 1 diabetes.

I am afraid that you are being overly appreciative of the C-peptide level. That value is certainly NOT elevated (as one might see in insulin resistance). So, it is measurable. Did someone tell you (falsely) that new onset type 1 diabetes presents with “no” insulin? It is deficient insulin. Eventually, after the honeymoon, there is essentially “no” insulin. Enjoy and strrreeeetch out this honeymoon.

If desired, your doctor could perform special pancreatic antibody testing (in a good laboratory please) for those immune globulins present in more than 90% of type 1 diabetes. They include GAD antibodies, ICA antibodies, and even insulin autoantibodies.

DS