Question: My 13-year-old daughter has recently been diagnosed with type 1 diabetes. We have read that this has been reversed in some cases through gradually lowering insulin dosage. Presently, she is controlling her blood glucose via diet in the daytime and taking no additional insulin after meals. She only takes slow-acting insulin at night, and her blood glucose levels are in the correct range. Is it possible to reverse type 1 diabetes and regain beta cell function?

Dr. Hibberd's Answer:

Type 1 diabetes is defined as the loss of glucose regulation. It is caused by the loss of insulin production as a result of a decrease in the pancreas’ insulin-producing beta cells. It is very important to treat this condition aggressively, as failure to treat may lead to significant premature organ failure (especially kidney) and loss of vision, not to mention ketoacidosis and coma which can cause death.

I favor the use of insulin pumps to achieve the best control, especially in active patients with fluctuating diets and activity day to day. The recent advent of non-invasive, needle-free glucose measurement should decrease the discomfort of close glucose management regimens. Inhaled insulin has been a disappointment, but nasal insulin still holds some promise for the near future.

There are documented cases of disease remission, but these remissions do not occur in response to any treatment. Type 1 diabetics are not usually overweight. Often they have a genetic factor, and autoimmune and viral components appear to be aspects that can result in a deficiency of insulin.

Treat her condition aggressively, as side effect and complications correlate directly with the degree of glucose control. Better glucose control equals less complication, less disability, less organ premature failure, healthier pregnancies, and a longer life expectancy as well as a more normal life. Do not delay treatment in anticipation of remission. Remission of type 1 diabetes without islet cell transplantation is actually very uncommon, but if it occurs, it will be very evident in improved glucose control on less and less insulin. This is an area of current research, and we may see a breakthrough in disease remission soon.