March 2013 up and running

Delayed sleep phase this month and chronotherapy which sounds like quite an undertaking.  Also a link to a new parent’s guide to picking up and talking about sexual abuse, links to handy recent uploads to the site, the BSACI guideline on allergic rhinitis and more banging on about vitamin D supplementation – please.

One thought on “March 2013 up and running

  1. As you say when a patient is diagnosed with type 1 diabetes they still do possess some endogenous insulin production, estimates vary but at diagnosis approximately 5% of islet cells are still producing insulin. This endogenous insulin production accounts for the “honeymoon period”, when exogenous insulin requirements are generally lower with notably less insulin needed for a set amount of carbohydrate, than is found for that patient later in the course of their disease. This period often lasts between 12- 18 months in children, longer if the initial control is good, and there is a theory that administering exogenous insulin from diagnosis rests these cells and allows them to survive for longer, hence prolonging this endogenous insulin production. The clinical consequence is that not only does the patient have smaller doses, their blood glucose levels are generally less erratic, and an excellent Hba1C is often seen.

    You mention measuring insulin levels in the blood, but as these levels would presumably vary according to the blood glucose levels I’m not sure how much value measuring an insulin level would be in determining the day to day insulin doses for a particular patient. We do of course use the glycosylated haemoglobin, the Hba1c, as a long term marker of control, and it is this measurement, rather than an insulin level, which I think is more comparable to the TSH in thyroid disease, and an incredibly helpful guide in conjunction with the blood glucose profiles when titrating insulin doses.

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