From Syracuse, New York, USA:
My daughter was diagnosed with Type 1 diabetes four months ago at age 15 months. A urinary tract infection triggered the diabetes. Her sugars were high for a short time (not more than 2 weeks) and since then have been mostly normal. Lately, however, she has had a few high readings. Her doctor is suggesting a morning dose of Ultralente and maybe later a bedtime dose. Right now her morning sugars are low 60's.
Can you tell me how long a range the honeymoon period may last? She is still in the honeymoon period. We've been hoping she doesn't really have diabetes but her doctor thinks she does with the occasional high readings and the presence of islet cell antibodies. Also, do you think its worth putting her on Ultralente? The doctor says it may extend the honeymoon period but it seems to me that we've going to be dealing with the insulin shots, more blood readings, and worrying about controlling her sugar levels so I'm not concerned it is worth it.
From what I understand from your question, your child is not yet on insulin, but had "transient" elevated blood sugars for approximately 2 weeks during an infection. Now, presumably the infection is resolved and the blood sugars have improved spontaneously without insulin, though occasionally there are some high readings and antibody studies are positive.
Technically, this is not really the honeymoon period yet. This usually refers to decreased insulin requirements after starting insulin therapy. We know that the pancreas gradually stops making insulin before the blood sugars become abnormal in children with insulin dependent diabetes. During an infection, insulin requirements go up. If the pancreas is normal (the child doesn't have diabetes), more insulin is made to keep the blood sugar normal during the infection. If the pancreas is slowly failing, it may make enough insulin to keep the blood sugar normal when there is no infection, but may not be able to make enough extra insulin to keep the blood sugar normal during an infection. This may explain why you saw abnormal blood sugars during the urine infection.
If antibody studies are abnormal indicating an ongoing inflammation in the pancreas, and your child is continuing to exhibit some abnormal blood sugars, there is some evidence to suggest that you may delay complete failure of the pancreas (and make control easier for a while) by starting insulin early. Ultralente theoretically would have the least risk of low blood sugars if the blood sugars are not elevated at all times.
Keep in mind, once you start insulin, your child may then enter a very prolonged "honeymoon" phase lasting perhaps for several years. During this time you will probably want to continue the insulin, even if at very low doses, as starting, stopping, and restarting insulin carries a very small risk of triggering insulin allergy or resistance. Also, if your child enters a very prolonged honeymoon phase on insulin, this is what you were hoping for by treating early, and stopping the insulin would defeat the purpose of starting it, unless your child were having low blood sugars.
Original posting 6 May 97
Last Updated: Tuesday April 06, 2010 15:08:54
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