From Logan, Utah, USA:
My 9 year old niece was diagnosed with Type 1 diabetes approximately 3 months ago. Her insulin had to be decreased until she has gone off it totally because her sugar stayed in target range. She is tested 4 times daily and has stayed in range with no insulin for the past month. Is this unusual or have you heard of this happening?
There are a number of possible explanations for your niece's story. By far the most probable is that she is a new onset Type 1A autoimmune diabetic and what is being observed is the normal and temporary recovery of the insulin producing cells after injections are started. This is often called the honeymoon period and during this phase (which can sometimes last for months) there are often pleas to reduce or abandon insulin. For a number of reasons, not all of which have to do with the immediate control of blood sugars, there is a case for continuing the insulin even in very small doses even if blood sugars and A1c tests are within normal limits.
In any case, if this is the diagnosis, insulin by injection or pump, or perhaps by inhalation someday, will be required for the rest of her life or until islet transplantation techniques are greatly improved.
In order to make sure of this diagnosis her parents should talk to her doctor about getting an antibody test done. A number for him/her to call is 1-800-425-8361. If this is positive then the diagnosis of autoimmune diabetes is confirmed. Some children who have an apparently typical onset of insulin dependant diabetes do not have a positive test though. This is true of about 50% of new onset cases in African American and Hispanic children in the US. In Caucasian children it is much less common, less than 5%; but it still occurs. In these Type 1B situations the onset is typical; but very often insulin needs last only a few months after which the blood sugar can be kept within normal limits with diet and exercise or perhaps with an oral hypoglycemic agents. Some of these children have chromosomal disorders; but for the most part the natural history of Type 1B diabetes has not yet been worked out. There are some other very rare possibilities, which do not present with an acute need for insulin.
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