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Question:

From Florida, USA:

My four year old daughter was diagnosed with Type 1 Diabetes in November 1996 [2 months ago]. Right now she gets 3 units of N in the am and 2 units in the pm. I was told she is in the honeymoon period. How long can we expect this honeymoon period to last?

Also, I have a 6 and 8 year old and wonder if they should be tested and whether the test they are using is an absolute indicator that they will get diabetes.

Answer:

The "honeymoon" or "remission" phase, when the pancreas temporarily starts making insulin again, can last anywhere from a few days to a few years. It may wear off gradually with a slow increase in insulin requirements, or abruptly with a rapid increase in insulin requirements.

The decision whether or not to have your other children tested to see if they have antibodies against the islet cells indicating a high chance of developing diabetes in the future is an individual one. Usually, testing is recommended if you are interested in participating in an ongoing trial to prevent diabetes.

In the United States, there is a national study (the DPT-I) testing the efficacy of giving either twice daily insulin injections combined with IV insulin for 4 days once a year or oral insulin to individuals at high risk of developing diabetes to try and prevent or delay the onset of this disease. The screening test is a simple blood test of Islet Cell Antibodies (ICA). If this is positive, it is repeated, and a blood test for Insulin Autoantibodies (IAA) and HLA type is performed. HLA is a marker of immunity on the chromosomes. There is a particular HLA type that decreases the risk of developing diabetes even in people with positive antibodies. Individuals with this HLA type will not be accepted into the study even if the ICA test is positive.

In addition the person is asked to undergo an IV glucose tolerance test where glucose is given intravenously and both blood glucose levels and insulin levels are measured after the IV glucose. In individuals with a high risk of developing diabetes, the blood sugar will remain normal, but less insulin than normal will be produced.

Depending on the results of the above tests, individuals felt to be at "high" risk for developing diabetes (at least 50% chance of developing diabetes in the next 5 years) or at "intermediate" risk (25-50% chance of developing diabetes in the next 5 years) may participate either in the insulin injection/IV insulin protocol (high risk individuals) or the oral insulin study (intermediate risk). You cannot choose which treatment study you wish to participate in, but are assigned according to risk. In each study, you have a 50% chance of being assigned to receive the actual treatment and 50% chance of either receiving no treatment (high risk study) or placebo pills (intermediate study).

No, as of yet, there is no test that is 100% accurate in predicting diabetes. There are both false positive results (people with abnormal antibodies who do not seem to go on to develop diabetes) and false negative results (people with negative antibodies who develop diabetes anyway). You must also remember even if antibody tests are negative now, they may become positive in the future and repeated testing is recommended if you are interested in participating in the study. Other antibody tests are also under evaluation, but are not being used as criteria for eligibility in the DPT-I study.

A few questions to ask yourself to help decide whether or not to have your children tested:

  1. How will you feel if your child is found to be at a high or intermediate risk of developing diabetes, but is assigned to watchful waiting or placebo? (You will not know whether your child is receiving a placebo or a real insulin pill, but you will know that your child is not receiving injections.)

  2. How will you feel if your child receives the treatment, but develops diabetes in the future anyway? Remember, if we were sure these treatments would work, there would be no need for a study.

  3. How will you feel if you decide not to participate in the study and find out in the future that one or both of the treatments is indeed successful and that you missed a chance of possibly receiving the treatment?

  4. Do you want to have your child tested if you do not wish to participate in the study? Do you want to find out your child may be at a significant risk of developing diabetes, if you don't want to do anything about it?

I recommend that if parents aren't sure whether or not they want to have their children participate, they consider first participating themselves if they are under 45 years, in good health, and not planning to become pregnant during the course of the study (5 years). This may help you decide whether or not you want to enroll your child.

TGL

Original posting 3 Feb 97

  
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Last Updated: Tuesday April 06, 2010 15:08:54
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