Prolonged honeymoon phase in an adolescent with diabetes and thyrotoxicosis provides support for the accelerator hypothesis

:  A 14‐yr‐old female presented with diabetes and Graves’ disease. Eighteen months later, she was euthyroid on carbimazole, and her haemoglobin A1c (HbA1c) was normal (5.2%) on a small insulin dose (0.3–0.4 units/kg/day). An assessment of her pancreatic beta‐cell reserve, determined by comparing HbA...

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Published inPediatric diabetes Vol. 9; no. 4pt2; pp. 417 - 419
Main Authors Abdullah, Nadeem, Al‐Khalidi, Omer, Brown, Kathryn J, Reid, Judith, Cheetham, Tim D
Format Journal Article
LanguageEnglish
Published Oxford, UK Blackwell Publishing Ltd 01.08.2008
Subjects
accelerator hypothesis
Adolescent
Diabetes Mellitus, Type 1 - complications
Diabetes Mellitus, Type 1 - physiopathology
Female
Graves Disease - complications
Graves Disease - physiopathology
Graves’ disease
honeymoon phase
Humans
insulin resistance
thyrotoxicosis
Thyrotoxicosis - complications
Thyrotoxicosis - physiopathology
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Summary::  A 14‐yr‐old female presented with diabetes and Graves’ disease. Eighteen months later, she was euthyroid on carbimazole, and her haemoglobin A1c (HbA1c) was normal (5.2%) on a small insulin dose (0.3–0.4 units/kg/day). An assessment of her pancreatic beta‐cell reserve, determined by comparing HbA1c and insulin dose, suggested that this was greater than other patients with type 1 diabetes in our service 18 months postdiagnosis (n = 185). We suspect that excess thyroid hormone led to an insulin‐resistant state and accelerated her presentation with hyperglycaemia. Insulin resistance fell once normal thyroid function was restored and helped to attenuate further beta‐cell destruction when beta‐cell mass was relatively well preserved.
ISSN:1399-543X
1399-5448
DOI:10.1111/j.1399-5448.2008.00347.x