Initial Phase

The first clinical signs in children are increased thirst, increased urination, and weight loss. Depending on how quickly the disease is recognized, the child may have only mild symptoms. If diagnosis is delayed, however, the child may fall into a coma. In 80 percent of children, it takes approximately three weeks from the onset of the first symptoms until type 1 diabetes mellitus is diagnosed.

Remission Phase

The remission phase is often referred to by the English term “honeymoon phase.” Two to three days after the start of initial insulin therapy, the child requires significantly less insulin than during the first days to bring blood glucose levels into the normal range. A further reduction in insulin requirements occurs after one to three weeks. The required amount of insulin can become very low. However, insulin therapy should not be discontinued completely. It has been shown that continued insulin treatment can prolong the remission phase. This is also biologically plausible: the few remaining functional beta cells that produce insulin are relieved by continued insulin administration and therefore survive longer. This phase may last only a few weeks or months, but sometimes several years. It is a very important period for educating both the children and their parents. However, this phase does not mean that the disease can resolve or be cured.

Permanent Phase

After the end of the remission phase, the child’s insulin requirement increases markedly. This is the point at which complete insulin deficiency develops. The pancreatic islets no longer produce insulin on their own.

Puberty Phase

During puberty, there can be pronounced fluctuations in metabolic control. Insulin requirements increase, and these fluctuations are often difficult for both the child and the parents to understand. In this phase, achieving good metabolic control is particularly challenging. Adolescents often reject the disease and neglect the necessary treatment.

Adolescence Phase

After the end of puberty, metabolic control stabilizes. During this time, insulin requirements decrease. In this phase, it is particularly important to reduce the insulin dose. Otherwise, significant weight gain may occur, as both the insulin dose and daily energy intake remain persistently above actual requirements.