The Switch from Insulin to Tablets
Reviewed by CDE Mehandi Sharma · Updated
This is the reason genetic testing matters so much, and for many families it is the best news they will receive about this condition.
If your baby's diabetes is caused by a change in the KCNJ11 or ABCC8 gene, insulin injections can usually be replaced by a sulfonylurea — most often glibenclamide, an inexpensive tablet that has been used in diabetes for decades.
The results are striking. In an international group of children with the commonest of these genes, 88% stopped insulin completely. Their average HbA1c — the three-month blood sugar measure — improved from 8.2% on insulin to 5.9% on tablets. Better control, and no injections.
It lasts, too. Ten years later, 93% of children in a follow-up study were still on the tablet alone, with an average HbA1c of 6.4%.
The transfer is done under close supervision, usually as an inpatient stay. The dose is built up over days while insulin is reduced, with frequent glucose checks. Doses in neonatal diabetes are much higher for body weight than in adult diabetes, which surprises families who look the medicine up.
Two honest caveats. Not every change in these genes responds — a few specific ones do not, and your team will know which. And success is much more likely the sooner it is attempted after diagnosis.