Pediatric Diabetes Mellitus - Free Board Questions of the Week

This week's free board review question...

An 8-year-old girl with new-onset diabetes is admitted to the hospital with diabetic ketoacidosis (DKA). She is treated appropriately; the DKA is resolved, and she is discharged home on long-acting insulin once a day and short-acting insulin with each meal. After 2 weeks on this regimen, she has a hypoglycemic seizure.

Which of the following represents a possible explanation for this event?

Answer Options

incorrect diagnosis of insulin-dependent diabetes mellitus (DM)
dawn phenomenon
sepsis
honeymoon phenomenon

And the answer is ...

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Correct Answer:

honeymoon phenomenon

Educational Objective:

Describe the presentation of the honeymoon phenomenon in new-onset diabetes mellitus.

Key Point:

The honeymoon phenomenon describes a period soon after a new diagnosis of DM when the child may not require as much insulin due to residual beta islet cells.

Explanation:

Following DKA and 2 weeks of successful insulin therapy, an incorrect diagnosis of DM is unlikely. By contrast, the patient may have some residual beta islet cells that are functioning at a high enough level for her to have some circulating endogenous insulin. This phenomenon is referred to as the honeymoon phenomenon, which, in a newly diagnosed patient, may require less insulin therapy for weeks to months and then will require increased doses when these beta cells also fail. The dawn phenomenon refers to hyperglycemia that occurs during the early morning hours. Sepsis is a possible cause of hypoglycemia, but the child will normally present with signs of infection, such as fever, vomiting, and illness prior to the event.

References:

Kliegman R, et al. Diabetes mellitus (chapter 589). In: Kliegman R, et al, eds. Nelson Textbook of Pediatrics. 20th ed., 2016:2760-2790. Levitsky LL, Misra M. Epidemiology, presentation, and diagnosis of type 1 diabetes mellitus in children and adolescents. Updated June 18, 2018. Accessed July 23, 2018.

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