Like the previous patient, this boy is still in the remission phase ('Honeymoon period'). He has one insulin injection a day. At the beginning of the week it was 12 units of a combined / biphasic insulin preparation (Comb 15). Diabetes control was good. There was hardly any sugar in the urine. The blood glucose readings - not very many of them - were 80 mg/dl (4.4 mmol/l) or 120 md/gl (6.7 mmol/l). There were no hypoglycaemic episodes.

On Wednesday the picture changed. At 6 p.m. and 10 p.m. urine sugar was 1% and the blood glucose level was 180 mg/dl (10 mmol/l). On Thursday there was again a "coloured picture": 1%, 2% and 3% urine sugar. Ketones still negative. Blood glucose 180 mg/dl (10 mmol/l) and 240 mg/dl (13.3 mmol/l). On Friday at 7 a.m. urine sugar was 5% and blood glucose was again 240 mg/dl (13.3 mmol/l). The boy therefore injected an extra 2 units of insulin. His metabolic state settled down again. The amount of sugar in the urine got less, and the blood glucose readings became satisfactory again.

The latest HbA_1c reading was 10.2% - which is not ideal. In recent weeks the insulin dose had had to be changed several times and is now nearly half a unit per kilogram of body weight. Before long he will undoubtedly have to change to two injections a day. The remission phase ('Honeymoon period') seems to be approaching its end.