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Question:

From Wichita Falls, Texas, USA:

Nearly 2 weeks ago we took our 4 year old daughter to the ER because she was having trouble breathing. She was diagnosed with pneumonia and Type 1 diabetes. (My father has Type 1). She had no symptoms of DKA, except her blood sugar level was 330. After 2-3 doses of insulin while in the hospital her blood sugar normalized and has remained so since then. We check her blood sugar before breakfast and before dinner, and it is between 73 and 125, except one reading before dinner was 57. Her pediatrician has decided that no insulin therapy is required at this time. Based on what I've read on your website about the benefits of continuing insulin during the honeymoon period, is this good if she is in fact in the honeymoon period? Is it possible she doesn't have diabetes at all? I don't believe she had any antibody tests. Should we request those? We're in the military and don't have ready access to a large medical center.

Answer:

This is not an uncommon dilemma. You need a bit more information. Was your daughter's HbA1c tested and was the value high? If it was, then she does have diabetes because this indicates that her sugars had been high for longer than a few hours. Stress such as pneumonia, admission to hospital and having blood samples taken can cause short term elevations of blood glucose.

I'm not sure if you are saying that her blood sugars have been normal since the two or three doses of insulin she had in hospital and she's had no insulin since then or if the normalisation took longer. If the latter then she certainly has diabetes.

As to whether withdrawing insulin in the honeymoon period is a good idea, I think there is now general agreement that it shouldn't be, provided the child is not having hypoglycaemic symptoms on very low doses. Occasionally one has little choice because hypos are happening with doses as low as 0.1U/kg. The withdrawal is usually only for a few weeks however until endogenous insulin production is insufficient.

Finally, if there's still doubt in your mind about the diagnosis (discuss this with your daughter's doctor) then antibody tests may help but can be negative at diagnosis.

KJR

Original posting 28 Nov 1998
Posted to Diagnosis and Symptoms and Honeymoon

  
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Last Updated: Tuesday April 06, 2010 15:09:02
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