The Honeymoon Period in Type 1 Diabetes

Dr. Fran Cogen Health Pro December 02, 2008
  • We recently discussed the top 10 concerns related to a new diagnosis of type 1 diabetes. Following these concerns, families then often talk about the "honeymoon" period.   What is the honeymoon period? Most kids/teens/adults with new onset type 1 diabetes have experienced symptoms and signs du...

18 Comments
  • Dr. Fran Cogen
    Health Pro
    Mar. 27, 2009

    Hi: I am sorry that I did respond to the post initially, as I don't know if I have a comment to previous blogs unless I scroll through each one by hand. In answer to your grandson's possible honeymoon period and the possibility of producing insulin after 2.5 years: the honeymoon period in patients with type 1 diabetes is variable and there is not a typical...

    RHMLucky777

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    Hi: I am sorry that I did respond to the post initially, as I don't know if I have a comment to previous blogs unless I scroll through each one by hand. In answer to your grandson's possible honeymoon period and the possibility of producing insulin after 2.5 years: the honeymoon period in patients with type 1 diabetes is variable and there is not a typical time period. I would love to know if your grandson was diagnosed with type 1 diabetes or type 1.5 which is a hybrid between type 1 and 2 diabetes. In these situations, insulin can be produced which therefore may resemble a honeymoon period. There are also genetic diseases (MODY) which can present in the same way. So, if you could give me a bit more information (like if he has GAD-65 antibodies etc.), I might be able to answer your question more specifically.

  • Anonymous
    Afifah
    Dec. 06, 2011

    I have a friend who's 15 year old daughter was diagnosed with type 1 in August 2011. She adopted a very low carb diet (i.e. only that in green leafy veg, no starchy veg and no grains) but a high fat (inc fatty meat, eggs, fish, dairy products). Her blood glucose is excellent and constantly between 4 and 6.5 before or after eating. Her thrush (vaginal and oral),...

    RHMLucky777

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    I have a friend who's 15 year old daughter was diagnosed with type 1 in August 2011. She adopted a very low carb diet (i.e. only that in green leafy veg, no starchy veg and no grains) but a high fat (inc fatty meat, eggs, fish, dairy products). Her blood glucose is excellent and constantly between 4 and 6.5 before or after eating. Her thrush (vaginal and oral), bartholin's cystes, hair loss and cessation of periods have all reversed. She takes no insulin at all now, though did use 10 units of slow acting insulin over night when the paediatrician insisted it was necessary. However, she went hypo one night 7 weeks ago so stopped using it and since then has been perfectly well and happy.

    Do you think this is an example of 'the honeymoon period'? I thought that occured when insulin was used, and this girl isn't using any, but the paediatrician gets flustered and says it is just the honeymoon period. Can you comment please? The mother gets very worried because the girl insists on doing it her way, which is opposed to the paediatrician and the dietician. The girl is fully grown at 5' 6" or so and her last two periods came 29 days apart, when they had been absent for 6 months.

    Thank you.

    • Dr. Fran Cogen
      Health Pro
      Dec. 06, 2011

      If you eat a very low carb diet, blood sugars will be much lower as reflected by the low amount of carbohydrates consumed. Because the pancreas is not as stressed with the need to produce insulin to cover the carbs, less or at times no insulin is required in someone that is most likely still producing insulin. The honeymoon usually occurs after the initiation...

      RHMLucky777

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      If you eat a very low carb diet, blood sugars will be much lower as reflected by the low amount of carbohydrates consumed. Because the pancreas is not as stressed with the need to produce insulin to cover the carbs, less or at times no insulin is required in someone that is most likely still producing insulin. The honeymoon usually occurs after the initiation of insulin - which is what nearly all pediatric diabetes care providers do- for treatment of new onset diabetes. The fact that she requires either no or small amounts of insulin is strongly suggestive of her own body producing some insulin and the honeymoon period. However, if one eats very little carbohydrates, blood sugar will remain low. The problem is that kids and teenagers are still growing and DO require some carbohydrates; so we tend not to restrict diet and provide the necessary insulin to cover the carbs. There is a movement in adults that uses very low carb diets with therefore less insulin required that achieve outstanding hb A1c's. This is very hard to do for adults, let alone kids. So, in summary, I believe the low hb A1c reflects a combination of insulin production by the teen with new onset diabetes (possibly honeymoon periods) AND less need for prandial insulin due to low carb diet. I hope this is helpful.

      Dr.Cogen

    • Afifah
      Dec. 06, 2011

      Hello again Fran, and thank you for your swift reply. You have clearly understood my brief outline, and I thank you again for that. Not everyone does, it seems.

      The reason for my reply is that first I want to agree with you that this 15 year old girl is, in my estimation, still producing some endogenous insulin, though GAD antibodies have been found. However,...

      RHMLucky777

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      Hello again Fran, and thank you for your swift reply. You have clearly understood my brief outline, and I thank you again for that. Not everyone does, it seems.

      The reason for my reply is that first I want to agree with you that this 15 year old girl is, in my estimation, still producing some endogenous insulin, though GAD antibodies have been found. However, I feel that the term 'honeymoon period' is being used to undermine her confidence in the excellent state that she is now in (her HbA1c is 6.4 and covers the period of 3 weeks prior to diagnosis) rather than support what she has chosen to do. I see no reason why this state of affairs cannot go on indefinitely, as long as the carbs are kept very low.

      Probably the paediatrician/dietician's noses has been put out of joint by this family's ability to fully grasp and follow the v. low carb diet, when they always think of it as difficult and present it as such, if at all. Once understood it is not at all difficult to follow, and this girl has proved that roundly. What is difficult is trying to keep glycaemia steady when eating carbs and using insulin. Not only tricky, but dangerous. More people die of hypos by using insulin, as you know, not of hyperglycaemia, which causes all the longer term destruction, much of which may be reversible, which death from a hypo is not.

      Apart from that I want to ask about the need for carbs for growth. Can you expain that to me. Are you thinking about insulin as a growth factor? I would say that it may be, but that growth occurs without carbs/insulin too, as long as protein and fat are available for tissue building and energy provision. Please correct me about this as I don't want to get this wrong.

      I know that a v. low carb high fat diet is used in many centres around the world for epilepsy, especially paediatric epilepsy, and used to be used in the 1920, prior to the invention of anti-convulsive drugs. Those kids, who may be started on the ketogenic diet when very very young, seem to grow alright and have been shown to have no higher risk of cardiac abnormality as standard dietary advice would suggest. It is certainly better than having uncontrolled seizures. You may also know that the ketogenic diet is being used for its neuroprotective effects in a huge range of other conditions, including Alzheimer's, Parkinson's, schizophrenia, bipolar disorder, obsessive compulsive disoder, polycystic ovarian syndrome, cardiovascular disorders, certain malignant brain tumours, and solid tumours anywhere in the body, because malignant cells can only grow through glycolysis, i.e. the burning of glucose. Remove the glucose and the tumours shrink. Note that Otto Warburg got the Nobel Prize for his work in this area way back in 1930! At the hospital named after him in Germany they take the absolute no hope cancer patients, put them on the ketogenic diet, and get a 50% cancer free result! Those that cannot stick to the diet are the 50% who die of cancer. And yet, the ketogenic diet is fundementally just the Atkins diet, which thousands of people willingly undertake for the sake of the weight loss it engenders. In fact I think many of the conditions I mentioned above were found to be fundementally glucose based prolems due to those individuals going on the Atkins diet and finding these other conditions improving or disappearing as a side effect!

      I feel this is a very important field for discussion and research, and welcome the opportunity to learn from, and (forgive me) teach others.

      Please repy. I am not arrogant, just keen.

      Thanks again.

      Afifah

    • Dr. Fran Cogen
      Health Pro
      Dec. 06, 2011

      Afifah: You ask very relevant questions. As I am not an adult diabetologist, I am unable to comment on many of your concerns. I do know, however, that in a teenager, it is very difficult to continue long term on a low carb diet or Atkins. Our dieticians recommend a balanced approach for all nutrients. Of course, the bottom line is if the diabetes is well...

      RHMLucky777

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      Afifah: You ask very relevant questions. As I am not an adult diabetologist, I am unable to comment on many of your concerns. I do know, however, that in a teenager, it is very difficult to continue long term on a low carb diet or Atkins. Our dieticians recommend a balanced approach for all nutrients. Of course, the bottom line is if the diabetes is well controlled and the teen has good quality of life, she should continue her present management. I will ask one of my blog associates to chime in if she has anything to add.

      Dr.Cogen

    • Afifah
      Dec. 06, 2011

      Well Dr Cogan, you are the first doctor that has been able to engage with me on this subject. All the others just defer to the received wisdom, trusting that it is right, even though if they put their own mind to it they would probably come to the same conclusion as me, which is: since diabetes is a disorder of carbohydrate metabolism by definition, removal...

      RHMLucky777

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      Well Dr Cogan, you are the first doctor that has been able to engage with me on this subject. All the others just defer to the received wisdom, trusting that it is right, even though if they put their own mind to it they would probably come to the same conclusion as me, which is: since diabetes is a disorder of carbohydrate metabolism by definition, removal of carbohydrates from the diet renders it disordered no longer. There is no such thing as an essential dietary carbohydrate  (unlike proteins and fats which are the two essential macro nutrients), and the small amount of glucose that the brain requires for it's normal function can be produced at the precisely required amount from proteins, without exogenous carbs at all, and all energy requirements can easily be supplied by fats, since they provide almost double the calorific potential of carbs.

      So, for the not insignificant proportion of people who suffer with any of the conditions mentioned in the last email, along with anyone who is overweight or who has hypothyroidism, depression or any autoimmune disease, or autism, ADHD, dyslexia and most neurological dysfunctions you can name, I believe the answer is a ketogenic diet with no more than 30-70g by-the-by carbs (i.e. in green leafy veg) daily. As long as plenty of fluids are drunk, and the fats are mostly saturated (i.e. not heavy on the polyunsaturates, which cause increased pg2s which are pro-inflammatory, and oxidative stress as the bonds break so readily), especially the medium chain fatty acids, such as coconut oil (which our species almost cerainly has eaten for many millenia, unlike grains).

      I look forward to the thoughts of your colleagues, and any diabetesologists. I am currently treating two cases of adult epilepsy with this method, both with great results. One of them has a big brain tumour, and it appears to be shrinking. He has had only one seizure since on the diet and it was very mild, short lived and with a short recovery time, unlike his previous extreme seizures. The other has absenses only, but whereas she used to have 40 per day she now has 8. I have an adult diabetic doing the ketogenic diet too, with excellent well maintained results for a couple of years now. It may be difficult for some people to stick to the diet, but I am doing it and I don't have any diseases at all, and I have been doing very well on it indeed for 2.5 years now.

      Awaiting your excellent thoughts.

      Afifah

  • mbwls03
    Jun. 03, 2011

    My daughter who is 7(almost 8) was diagnosed with type 1 diabetes about a month ago. She was put on 7 units of Lantus 1 time a day and a sliding scale at meals for BG over 200 and carb intake at meals.  I know alot about this disease and how to take care of it being that I was diagnosed as a child and have been on insulin for 19 years, and started...

    RHMLucky777

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    My daughter who is 7(almost 8) was diagnosed with type 1 diabetes about a month ago. She was put on 7 units of Lantus 1 time a day and a sliding scale at meals for BG over 200 and carb intake at meals.  I know alot about this disease and how to take care of it being that I was diagnosed as a child and have been on insulin for 19 years, and started on an insulin pump about 7 years ago. She was doing very well, her BG were getting under control and and she had only had a few high numbers ( all this with taking the insulin as perscribed) Then about a week ago I got a call from her school and her BG was 44, they took care of it and I headed to go pick her up...but this puzzled me! We hadn't changed anything, she was covered at school with insulin for the only the carbs that she had for lunch and they always call me at that time to verify everything. That evening she was low again, and then the next morning and all that day...she couldn't keep enough food in her. That night I did not give her dose of Lantus to her, I was afraid she would bottom out in her sleep. The next morning she was at 88...perfect! So I decided to not give her any carb coverage and just check her BG after she ate and see what it was doing. That's what we have been doing for 3 days now and her BG has not been over 127 and that is after she has eaten.  The first day that she didn't have any insulin I started learning a little bit about what is going on (tried to call her doctor...no call back yet) I found the stuff about this "honeymoon" period. I had never heard of it. I didn't go through it when I was diagnosed, I have taken insulin since day 1 of my diagnosis. What I am reading is that an insulin regimen should still be in affect, to assist the cells that are functioning properly, but how do I do this knowing that she is going to get too low? What should I do? I know I have to discuss this with the doctor but her appt is still a week away and I can't get a call back.  Is she okay not having any insulin at all, as long as her BG is not going high. Is this to be considerd the "honeymoon" period, or should we be Thanking God for a Divine Healing! How long will this last?  I need some answers please! 

    • Dr. Fran Cogen
      Health Pro
      Jun. 19, 2011
      Sorry it has taken so long to get back to you as I am not automatically notified when a comment has been made. Yes, it appears that your child is in the honeymoon period. I hope you have had a conversation with your doc by now. I generally try to maintain minimal amounts of insulin to keep the beta cells producing insulin. But if she still goes low, I would...
      RHMLucky777
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      Sorry it has taken so long to get back to you as I am not automatically notified when a comment has been made. Yes, it appears that your child is in the honeymoon period. I hope you have had a conversation with your doc by now. I generally try to maintain minimal amounts of insulin to keep the beta cells producing insulin. But if she still goes low, I would discontinue insulin and check blood sugars frequently. Dec
  • Anonymous
    Rosie
    May. 13, 2009

    My nephew was diagnosed with and insulin dependant 2 years ago.  He did have a brief honeymoon period.  In the last week he has been complaining of stomach aches...but with this he has dramatic sugar lows. He is on the Lantus and humlog.  In past few days we have not give very much of the humlog because of the drops.  and we lower his lantus. ...

    RHMLucky777

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    My nephew was diagnosed with and insulin dependant 2 years ago.  He did have a brief honeymoon period.  In the last week he has been complaining of stomach aches...but with this he has dramatic sugar lows. He is on the Lantus and humlog.  In past few days we have not give very much of the humlog because of the drops.  and we lower his lantus.  We are bringing him to the doctor tomorrow, but just wonder if you have any idea why he would do this.  I do believe he as diagnosed with 1, but also floated between the 2.  His younger sister is type 1 and she is easy to recover from a low, but we have trouble with him at times...for example yesterday he was at 50 and we gave him 2 fruit packs - 20 carbs each, Mcdonalds adult meal, a small OJ(intially), a few drinks of regular pop and not humlog...a few hours later we checked him and has 184!!! i could not believe he was not like 300-500 or something. any ideas?

    • NINA DIEHLMAN
      Apr. 20, 2010

      MY GRANDSON WAS DIAGNOSED 5 WEEKS AGO...2 WEEKS ON INSULIN AND THEN OFF...SUGARS WENT TO 30...NO INSULIN NOW BUT HE IS UP AND DOWN ...128 DOWN TO 20  IN 30 MIN. HE IS HAVING A HARD TIME ..WE GIVE HIM  DRINKS AND CAKE AND CANDIE TO BRING IT UP...THEN HE GOES LOW AGAIN....NOW I MAKE HIM A SMALL GATOR AID WITH 4 TABLESPOOS OF CORN STARCH BEFOR EVERY...

      RHMLucky777

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      MY GRANDSON WAS DIAGNOSED 5 WEEKS AGO...2 WEEKS ON INSULIN AND THEN OFF...SUGARS WENT TO 30...NO INSULIN NOW BUT HE IS UP AND DOWN ...128 DOWN TO 20  IN 30 MIN. HE IS HAVING A HARD TIME ..WE GIVE HIM  DRINKS AND CAKE AND CANDIE TO BRING IT UP...THEN HE GOES LOW AGAIN....NOW I MAKE HIM A SMALL GATOR AID WITH 4 TABLESPOOS OF CORN STARCH BEFOR EVERY MEAL AND AT BEDTIME....WE WILL SEE....HAD MRI....CAT SCAN ....BLOOD WORK...NO ONE KNOWS AT SHANDS...THEY SAY HE IS HONEYMOONING BUT THIS IS NOT TYPICAL......

    • chris
      May. 27, 2011

      When you give a child juices, sugar, etc. to bring up his sugar level...it is temporary. In fact, I found with my son it'll spike him then drop him just as quickly after a little while. What you need to do when your child is low is give him Complex Carbs (ie, crackers and cheese). These will bring up the sugar and stabilize without the quick spike and drop....

      RHMLucky777

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      When you give a child juices, sugar, etc. to bring up his sugar level...it is temporary. In fact, I found with my son it'll spike him then drop him just as quickly after a little while. What you need to do when your child is low is give him Complex Carbs (ie, crackers and cheese). These will bring up the sugar and stabilize without the quick spike and drop. My son was diagnosed last July. He's on Lantus (7u) 1 a day and he only uses humalog if he's going to each something high carb (pizza) - even then he doesn't take much if at all (.5u). Basically he's been able to manage the diabetes with the Lantus solely. His numbers are always between 70-150

  • Anonymous
    George
    Mar. 09, 2009

    It is known, that we don't know much about the causes of diabetes. This honeymoon period hypothesis, has been shown to have several flaws and it looks like it isn't applicable on all cases.

     

    Diabetes can be caused, it seems, by serveral problems, toxins (like alloxan, STZ, dioxin), excessive carbohydrate consumption, genetical sources (Mody), malnutrition,...

    RHMLucky777

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    It is known, that we don't know much about the causes of diabetes. This honeymoon period hypothesis, has been shown to have several flaws and it looks like it isn't applicable on all cases.

     

    Diabetes can be caused, it seems, by serveral problems, toxins (like alloxan, STZ, dioxin), excessive carbohydrate consumption, genetical sources (Mody), malnutrition, there are some theories about milk causing it.

     

    The problem is, that all those problems may cause the body to produce antibodies and or DNA damage that will have repercussions in glucose homeostasis and body homeostasis (water, minerals, vitamins, etc...) in general.

     

    B Cells can regenerate if the source of the problem, most of the time discovered by chance, is identified.

     

    There are people, diagnosed with DM Type I, that have an underlying problem called latent or silent coeliac disease (allergy to gluten). Some of them will develop the typical antibodies of Type I, GAD65, ICA, etc... Usually, whith changing the diet DM will disappear after a time of adhering to a gluten free diet.

     

    There are some estimations, that a percentage, as high as 16%, of Type I diagnosed diabetics have the underlying problem of this latent coelicac disease.

     

    To me, the characterization by Type I, II, 1.5, III are erroneous. We should go more by the antibodies present. Like DM GAD65 or DM ICA, GAD65. Diabetes Mellitus being only the symptom of an underlying, probably solvable, problem. Whitout identifyin the underlaying problem, therapy will be suboptimal and heavily insulin dependent.

     

    Diabetes mellitus is about an homeostasis imbalance and toxicity. Through dietary corrections, by avoiding certain nutrients, diabetes symptoms may improve the therapy greatly.

     

    I'm for example classified as a Type I, which is quite a feat to view me as such, since I'm not insulin dependent. The diagnosis of Type I was solely based on the presence of a high amount of GAD65 antibodies. After going to a low carb diet, my diegestive problems, that I've had for years, are disappearing and my BG is well controlled, in between 50 and seldomly 140, usually below 120.

     

    I can't imagine what would happen if I was injecting insulin, probably low all the time. I only injected insulin for 3 days.

    • Anonymous
      liz
      Jun. 11, 2009

      wow - it is fantastic to hear of someone else controlling their type 1 solely through diet. That is exactly what our daughter, Emma, is doing. she is also on a low carb diet and has been off insulin since August 16th last year, although she hardly took any between being diagnosed (end of last June) and last August in any case. Most doctors and diabetics people...

      RHMLucky777

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      wow - it is fantastic to hear of someone else controlling their type 1 solely through diet. That is exactly what our daughter, Emma, is doing. she is also on a low carb diet and has been off insulin since August 16th last year, although she hardly took any between being diagnosed (end of last June) and last August in any case. Most doctors and diabetics people are very sceptical and even quite aggressive - which i think is trange, since surely it's a good thing?! she is not at all malnourished and positively glows with health, although it is difficult for her at times to adhere to the eating regime. I totally agree that the underlying cause must be able to be corrected, whether it is gluten, dairy or yeasts (another very likely probability) that kick it all off.

       

      Do keep posting and updated on progress

    • Anonymous
      Anonymous
      Jan. 15, 2010

      please tell me more about  your daughter Emma controlling her type 1 diabetes through diet.  My son was recently diagnosed with type 1 and took insulin for about 3 days. for now he doesn't need it.  we've been controlling his carb inake.

    • Anonymous
      jms
      Jul. 25, 2009

      that is so good to hear this. My son has been diagosed on Monday .  His blood sugar tonight was 108 adn was 281 night before.  He is entering honey moon I believe.  What kind of diet do you use- please let me know.  Thank you

    • Anonymous
      George
      Jul. 25, 2009

      Hi Liz, Hi JMS

       

      I'm still alive an kickin' :) As of late I'm doing too well sometimes, the lowest I've measured was 2.5, the highest 7, for the last month.

       

      What I'm eating is, apparently, very unhealthy. Lots of fat, some proteines and minimal carbs (only those contained in veggies and chocolate every 2 months or so). The chocolate I eat is to...

      RHMLucky777

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      Hi Liz, Hi JMS

       

      I'm still alive an kickin' :) As of late I'm doing too well sometimes, the lowest I've measured was 2.5, the highest 7, for the last month.

       

      What I'm eating is, apparently, very unhealthy. Lots of fat, some proteines and minimal carbs (only those contained in veggies and chocolate every 2 months or so). The chocolate I eat is to stress the system and to see what happens, I will eat around 50gr of milk chocolate that usually will send me to 8 or 12, depending on what I ate the last 48 hours. Wheat (contains gluten, an opiate like heroine) sends me rocket high (+14), even small amounts...

       

      What I avoid, foods containing gluten, glutamate, soy, starches, beans, rice, potatoes, generally speaking, all foods than unprocessed uncooked are poisonous to the human body. I avoid fruits in general, if any, wild ones, they don't taste that good, usually very acid and hard like wood, but at least they don't have those humungous amounts of fructose and glucose, like apples you can buy at the grocery.

       

      Dairy is also something I avoid, I get digestive problems when I eat it (cheese as it contains no lactose, another sugar), but it is improving it seems, I just test every 2 months, like with chocolate.

       

      What I eat, lots of nuts, berries (including strawberries), lots of fatty meat, fish, seafood, salads, raw veggies (like raw broccoli with the salads), actually I don't cook any of the veggies I eat, seeds (sunflower, pumpkin), onions and garlic being very important, lots of canola, sunflower and olive oils. For teas, I can recommend green tea, although you have to be very careful if you want apply all of this to your child, an adult has a different metabolic rate than a child, and a child cannot decide for him/herself...

       

      Also stuff that seems to be very helpful, at least on me, caffeine containing brewerages, like sugarless colas or sugarless energy drinks and the occasional alcoholic drink, like wine or burning waters, excluding grain based distillates. Those are clearly not suited for a child!!!

       

      I don't eat breakfast, I think it's not a good idea, at least for me. I skip sometimes meals or let one day out.

       

      I supplement zinc (zinc is central for building an insulin molecule), chromium, vanadium, biotin, ala, calcium, magnesium, etc... all of this intermittently.

       

      I think that a lot of autoimmune diseases have a strong connection to the nervous system, so keeping my temper down, surely helps a lot.

       

      What you eat is what you are and we're no stinkin' cows. They have 4 stomachs to process the cereals or grains they eat, we have only one and an ill suited one for that kind of food.

       

      As I wrote before, this works for me extremely well, so well that now I have normal glucose levels, coming down from >14% HbA1c to 5.6% in only 6 months. It may be not applicable for other adults, that may have another source for their glucose problem. But I strongly believe that this can be generally said: avoid gluten, glutamate, soy and dairy. All of those mess with the digestive and nervous system on a lot of people, including myself, some act even like cocaine or heroine at low dosages.

      Thank you for your time, take care and track your blood pressure, keep it lowest, that is helpful against glycation (HbA1c) of cells even if your blood sugar is sometimes high :)

       

      Just my 2 ct

    • pgy
      pgy
      Jun. 20, 2011

      George

       

      any updates?

       

       

  • Anonymous
    Anonymous
    Feb. 22, 2009

    How long can a honeymoon period last? My grandson pancreas started making insulin after 2 1/2 years, the doctor said it was the honeymoon period, is this normal?