Male1: If you were concerned with a child who is developing the classical type I diabetes, what would be the signs of that?
Male2: The signs are that the typical and classical—the triad of three Ps, and one is polydipsia, that means increased drinking; polyuria, increased urination and polyphagia, increased appetite, increased food intake. That is how I would say maybe majority of children are diagnosed maybe not by a doctor, maybe by the parents who notice that suddenly, the child goes to the bathroom quite often, is drinking all the time. They might dismiss it. It might be odd weather, maybe it is a habit, maybe everybody else in the family is drinking all the time, but I think at that point, when you have a healthy child who suddenly starts to drink much more than previously and is going to the bathroom especially at night that person should be tested for diabetes and you certainly would like to do blood sugar level, but even if you check the urine for glucose that will give you a hint.
Male1: What blood sugar level fasting you could diagnose as diabetic or not?
Male2: Well, we have new classification nowadays. Now fasting blood glucose and it applies to the pediatric age group should be less than 100 mg% or less than 100 and if blood sugar is over 126mm%, that would be called diabetes and if you have blood sugar between 100 and 126, talking about fasting blood glucose, that is called impaired glucose tolerance. In the past, we would call it comical diabetes—that term is not used anymore. So fasting glucose after a good overnight fast should be less than 100 and if it is between 100 and 126, it is abnormal. It needs more investigation. If it is more than 126 that is the diabetic range and then it is not enough to have one blood sugar. You need also—what happens to your blood glucose when you eat and that is called post prandial. Usually, we do it like two hours, you might do like a glucose tolerance test or at least good carbohydrate meal and it should be less than 140, so normal blood sugar fasting should be less than 100 and two hours after meals should be less than 140.
Male1: Once a kid is diagnosed correctly with this, do they ever go to a period where they not even eat insulin for sugar?
Male2: That is correct. They go. It is called the honeymoon period because the honeymoon will not last forever or partial remission. I would say maybe half of people who are diagnosed with type I diabetes, they go through some sort of honeymoon period.
Whether they can be taken off insulin completely, that set may happen, but it is very, very rare. And also it depends how severely diabetic are you when you are diagnosed. People who have very high blood glucose levels, they go through what we call diabetic ketoacidosis; they probably have diminished insulin secretion to the point that they will not go through a honeymoon period, but people who are picked up accidentally, pre-school physical and urine check shows sugar in the urine, blood sugar is a little elevated, drop with insulin, they often can go to a very, very good honeymoon period. And it can last anywhere from a couple of months to a couple of years. By definition, honeymoon period is not necessarily that you stop insulin but if the insulin requirement a few weeks after the diagnosis drops by 50% that is called honeymoon. The question always goes how you can prolong this honeymoon, what can you do in those kinds of studies, but most patients—and we have not seen and we see I would say at least 40 or 50 maybe 80 probably more than 80, maybe 100 plus newly diagnosed type I diabetics in our clinic at Schneider Children’s Hospital a year, and I do not recall one who we could be able to take off insulin completely.
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