Endocrine Abstracts

Introduction: At the onset of type 1 diabetes mellitus (T1DM), children often experience a partial remission which is characterized by decreased insulin requirements. Usually, some exogenous insulin is still needed during this honeymoon phase. We present cases of 2 children with T1DM who had significantly extended periods where no exogenous insulin was required. Case 1: 12-year-old girl presented with fatigue and weight gain. HbA1c in primary care was 51 mmol/mol. BMI was +3 SD. She made immediate significant changes in diet and physical activity. Continuous glucose monitoring one week later showed time in range of 92% without any medication. GAD antibodies were strongly positive. Lifestyle changes were maintained, BMI fell to 98th centile, and HbA1c dropped to 31 mmol/mol, remaining normal for 2 years. Working diagnosis was possible type 2 diabetes mellitus and she was monitored 3 monthly in diabetes clinic. 2 years later she developed osmotic symptoms after a period of increased snacking and reduced blood glucose testing. HbA1c was 92 mmol/mol and blood glucose 19 mmol/l. She was commenced on multiple daily dose insulin. Within 4 months her HbA1c reduced to 29 mmol/mol with 95% time in range. Case 2: 12-year-old boy presented with lethargy, weight loss and nocturia. Blood glucose was 18 mmol/l, ketones 5 mmol/l, pH 7.29, HbA1c 99 mmol/mol. IA-2 antibodies were strongly positive. He was started on multiple daily dose insulin. He followed a healthy diet with low snacking and exercised regularly. Insulin was stopped after 2-3 weeks due to hypoglycaemia. Over the next 15 months HbA1c was maintained at 35-37 mmol/mol without insulin. 17 months after the initial diagnosis blood glucose levels began to rise and he was restarted on insulin injections. HbA1c at resumption of insulin injections was 43 mmol/mol.

Conclusion: Extended honeymoon phase can be seen in children with diabetes. Common characteristics of our patients were healthy diet with low snacking, regular exercise, and in one case significant weight loss. Careful communication with families to ensure good understanding of the honeymoon phase is important, including regular blood glucose monitoring to detect changes early.