From Chaco, Argentina:
My son is 11 years old and was diagnosed with Type 1 diabetes nine months ago. His weight has not increased. Before his diagnosis, his weight was 38.5 kilos; now he has the same weight. The initial time of his illness began with a blood glucose of 300 and the classic symptoms. He began insulin therapy, but he was presenting with hypoglycemia during morning so the doctor decreased the dose until on only 1 U NPH insulin per day, so we travelled to a hospital in Buenos Aires where the Metabolic Unit team's decided to discontinue the insulin.
Their explanation was that my son was in a period called the "honeymoon", and in this period the pancreas continues to make insulin. Now in my country, it is autumn and my son's glycemia is increasing, 145-150 when fasting and 200-300 postprandial. My questions are:
- Is his weight normal or should he have been increasing?
- When should he begin with insulin therapy again?
- The honeymoon period exists. How long does it last?
- Is the hyperglycemia related with the seasons?
In answer to your questions:
- A body weight of 38.5 kg is right in the middle of the normal range for an 11 year old boy. In most instances I would have expected him to have gained some weight since diagnosis and there could be several reasons why this has not been the case, which you might want to discuss with his doctor: a) he may not have been getting enough insulin during his 9 month honeymoon period, b) his diet may have been unduly restricted, and c) his thyroid gland may be underactive; this a common condition in association with diabetes in children and can be easily tested for and treated.
- Yes, you should indeed start giving him insulin again. Over the next few weeks his total daily insulin needs will probably increase to a total of about 30 units; but you need to keep in touch with the doctors about what kinds of insulin to give, when, and in what amounts.To begin with, insulin needs will be much smaller than this.The simplest regimen would be to give one part of regular insulin to two of NPH before breakfast and before supper, with a total dose before breakfast about twice that before supper. Nowadays many children will get some form of 'intensive' treatment for example using Humalog insulin just after a meal adjusting the dose according to the pre-meal blood sugar and appetite plus a dose of Ultralente insulin in the morning or before supper. Pork insulin is not much used these days; but not all the others may be available everywhere in Argentina.
- The duration of the honeymoon period is very variable. It may never occur or it may last over a year: Present policy is to continue with some insulin during this phase even if it involves very small amounts.
- Blood sugar levels are not related to the seasons except in so far as the intake of carbohydrates may increase in the cold weather.
Original posting 22 Jun 2000
Posted to Daily Care
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