mayday
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can any one explain why you don't need to treat this condition. the kaplan notes say in honeymoon period 'epinephrine release blocks insulin secretion'. but if insulin level is low, you should have very high blood glucose. is it right?
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| nisha
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Well the way Conrad Fischer explained it is that often during times of stress some residual beta cells are still able to produce enough insulin, so the diabetic may not clinically manifest, (the blood glucose will not be high) However when these cells are destroyed, there is complete insulin deficency, so, in order to preserve the function of any surviving insulin producing cells we should start low dose insulin therapy, (it's a prophylactic measure).
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| mayday
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But still what is the difference between the honeymoon period and after that, I mean what happens to the beta cells? Do the beta cells all destroyed after heneymoon so you need to increase the dose of insulin? Does IDDM pt have any functional beta cell left?
Edited by mayday on 09/27/05 - 01:48 PM
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| nisha
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eventually the honeymoon period does end, it doesn't have to be after 1 stressful situation (infection), but it will eventually (all the left over insulin producing beta cells stop producing it) then the person will manifest with overt signs of DM and insulin will definitly have to be started, thus, better to keep on low dose insulin right from the beginning of the honeymoon period, and continue so the body can continue to withstand further stresses
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| ARJ
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The pancreatic functional mass goes on declining as the IDDM develops. Its not a day event. It takes time for the full blown IDDM to precipitate. Full blown IDDM manifestation develops only after the functional pancretic Beta cell reaches its lowest level that can be called as its theresold level. The patient remains asymptomatic even though there is a decrease in the functional pancreatic mass. Its a linear decline in the pancreatic mass secondary to insulinitis.
When there is Stress full event eg infection there is a sudden drop of the functional pancreatic tissue ( insulin secretion ) plus the action of the conteractive hormone epinephrine. This can manifest eg as Ketoacidosis (In normal adult complication of hyperglycemia will never developed secondary to the increase in the insulin secretion). Hence there is a dip in the linear curve of the functional pancreatic beta cells. You start the patient with Insulin suspecting IDDM but as the infection gets cured the patient recovers from that stress full event and the functional pancreatic mass reverses back to the preinfectious state. The dip in the linear declining curve gets back up again to the linear declining path.The patient will stop medication (insulin) as he recovers.
But as the insulinitis is still in progress. Th patient eventually will develop full blown IDDM.
Thus the point is, in the window period ( Asymptomatic period) the patient should be given low dose Insulin. You have to protect the whatever left pancreatic mass rather then stressing it.
Yes Beta cell are destroyed after the Honeymoon period. But our aim should be in the best of the patient to prolong the time between the onset of the insulinitis and its clinical manifestations
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| nisha
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well said! I wish we could put graphs on here to explain stuff 
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| mayday
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that's very nice. kaplan prefer not treat the honeymoon period it's different from Conrad Fischer. 
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