Continuous Blood Glucose Monitoring in Newly Diagnosed Type 1 Diabetes

[Northerner]

A 25-year-old graduate student presented to the endocrine clinic with insidious onset of recurrent hypoglycemia. She was diagnosed with type 1 diabetes 7 months prior, following an episode of mild diabetic ketoacidosis (DKA) successfully treated in the emergency department (ED).

She initiated basal bolus insulin therapy with dramatic improvement in her HbA1c from 13.4% at diagnosis to 6.1% within a few months after starting insulin therapy. Her initial labs confirmed type 1a diabetes with a markedly elevated glutamic acid decarboxylase-65 antibody titer and a low, but not entirely undetectable, C-peptide level of 0.32 ng/mL. She is otherwise healthy without other medications or comorbidities, except for a daily oral contraceptive pill. Her BMI is 22 and her total daily insulin dose was 0.4 units/kg at the time of follow-up 3 months after her initial diagnosis.

Within a few months after diagnosis, a personal continuous glucose monitoring device (CGM) was prescribed, which measures glucose changes in the interstitial fluid in the subcutaneous tissue. CGM is often a useful adjunct for close glucose monitoring in an active young individual with type 1 diabetes.

http://www.endocrinologyadvisor.com/continuous-glucose-monitoring-in-type-1-diabetes/article/391865/

The so-called “honeymoon” period in type 1 diabetes is characterized by reduced exogenous insulin requirements while glycemic control is well maintained (i.e., partial remission.) It may develop relatively soon after the diagnosis of autoimmune diabetes and is regarded as a transient phase of remission occurring due to the development of adaptive immune tolerance and possibly related to improvement in beta cell function after resolution of acute glucose toxicity. It is associated with significant residual endogenous insulin production mirrored by a decreased need for exogenous insulin.
This process has been clinically defined in various ways. A practical clinical approach may be to consider this diagnosis when the total daily insulin dose is less than 0.5 units/kg body weight per day while still resulting in an HbA1c of less than 7%.1 Alternatively, a daily insulin dose of less than 0.3 units/kg body weight per day resulting in an HbA1c of less than 6% may be considered a more stringent definition.2

My current units/kg is 0.23 and my HbA1c is 5% 😱

 

[KookyCat]

Good grief, my lot said oh you're probably honeymooning just be careful with the insulin....no here have a CGM for me. They did snigger (yes snigger) at my 7 units of novorapid a day, and then said have jelly babies by your bed for night time hypos. They were less sniggery when I said "I'm so glad you told me that because I was just going to lie there until I hit a coma and then have a biscuit" and I had my snarky face on which is not pleasant for anyone, snarky face is getting worse too, I feel quite sorry for them 🙄