Understanding the Honeymoon Period in Type 1 Diabetes
Many questions/comments appear on this site in regard to the honeymoon period:
1. What is it?
2. How do I know I am in it?
3. How long will it last?
4. How do I prolong it?
5. Do I need to continue insulin if blood sugars are in range?
6. Is it better to be out of the honeymoon period so that insulin adjustments are easier?
7. How do I know that the “honeymoon is over?”
8. How do I get over my feelings of “loss” after transitioning out of the honeymoon period?
9. Are there any research trials that prolong the honeymoon period?
1. What is it? The honeymoon period usually occurs after the child/young adult/adult is diagnosed with type 1 diabetes and has begun insulin treatment. After several weeks to several months (the time is variable), the person with diabetes starts to produce his/her own insulin (endogenous insulin) secondary to some recovery of pancreatic islet cells. After the clinical development of diabetes, it is well known that NOT all pancreatic islet cells are destroyed. With the addition of exogenous insulin (shots), the glucose bathing the islet cells (glucose toxicity) is decreased and the islet cells begin to puff out some insulin.
2.** How do I know I am in it?** With the addition of exogenous insulin via injection along with your own endogenous insulin, the body becomes extremely efficient in managing blood sugars. Blood sugars come into range very quickly and are often tightly controlled with very little fluctuation. The amount of exogenous insulin required to maintain stable blood sugars is rapidly decreased. For example, most people produce about 0.6-1.0 units/kg/day of body weight. If you have lost the ability to produce any insulin, your body requires 0.6-1.0 units/kg of body weight to bring blood sugars into range. Thus, if your body is producing its own insulin, you will require less insulin by injection (0.3 units/kg/day). In addition to the decreased amount of exogenous insulin, your blood sugars will be in a very narrow range (80-150-with occasional higher numbers) especially before breakfast. Therefore, there will be less variability of blood sugars.
3.** How long will it last?** There is no defined amount of time. Honeymoon periods can last from two weeks up to 2 to 3 years. It is different for each individual. Sometimes, if the diabetes diagnosis is determined extremely early (with less destruction of beta cells), the honeymoon period can last even longer.
4.** How do I prolong it?** The best way to prolong the honeymoon period is to administer insulin. Even injecting 1 unit of insulin will enable the existing pancreatic beta cells to produce insulin (until they are eventually destroyed by the autoimmune process). If blood sugars are “perfect” in the honeymoon period, I generally try to continue at least a tiny amount of exogenous insulin. (Remember, without insulin diabetes was diagnosed)
5.** Do I need to continue insulin if blood sugars are in range?** Yes (in my opinion); see above.
6.** Is it better to be out of the honeymoon period so that insulin adjustments are easier?** Some families have expressed a desire for the honeymoon period to end to get down to the business of full insulin adjustment. In my opinion, I would prefer for the honeymoon period to continue as long as possible to maintain the best glycemic control for the greatest length of time. In this way, the potential for any microvascular complications would be delayed even further.
7.** How do I know that the honeymoon is over_?_** The most typical course is that the blood sugars become more erratic and do not remain in a tight range. In addition, blood sugars become higher and less predictable. Exogenous insulin requirements increase. Often, prior to the end of the honeymoon period, the child/adult has some sort of stressor (puberty and hormones, viral infection, etc.) that requires the need for more insulin that cannot be met by pancreatic islet cells. So, if you see blood sugars that are more erratic, increased highs and lows, as well as the need for increased exogenous insulin, the honeymoon period is likely over.
8.** How do I get over my feelings of “loss” after transitioning out of the honeymoon period?** Generally, after the honeymoon period wanes, the reality of diabetes management and self-care skills becomes much more immediate. During the honeymoon period, most people with diabetes could perhaps get away with extra carbohydrates or dietary indiscretions without much effect on blood sugars. After the honeymoon, this is no longer possible and attention to nutritional management, exercise, and insulin timing and administration becomes extremely relevant and immediate_._ Therefore, most people feel differing emotions regarding this transition and work with Diabetes team to once again feel empowered to care for themselves or their child/young adult with diabetes.
9.** Are there any research trials that prolong the honeymoon period?** Yes, indeed, there are. Please check my previous research blogs, especially the monoclonal antibody study pioneered by Dr. Kevan Herold, which prolongs the honeymoon period by blocking the killer T cells enabling the continued endogenous insulin production by the pancreatic islet cells.
I hope this information will help answer any questions that you may have in regards to the honeymoon period. Please feel free to ask further questions in the comments section.
Fran Cogen, M.D., C.D.E., is the director of the Childhood and Adolescent Diabetes Program at Children’s National Health System. She wrote about diabetes for HealthCentral.