What Is The Honeymoon Period In Type 1 Diabetes?
Does everyone experience this? The “honeymoon period” is a phase that some people with type 1 diabetes experience shortly after being diagnosed. During this time, your diabetes may seem to go away. You may only need minimal amounts of insulin. Some people even experience normal or near-normal blood sugar levels without taking insulin. This happens because your pancreas is still making enough insulin to help control your blood sugar. Not everyone with diabetes has a honeymoon period, and having one doesn’t mean your diabetes is cured. There isn’t a cure for diabetes, and a honeymoon period is only temporary. Everyone’s honeymoon period is different, and there isn’t a set time frame for when it begins and ends. Most people notice its effects shortly after being diagnosed. The phase can last weeks, months, or even years in some cases. The honeymoon period only happens after you first receive a diagnosis of type 1 diabetes. Your insulin needs may change throughout your life, but you won’t have another honeymoon period. This is because with type 1 diabetes, your immune system destroys insulin-producing cells in your pancreas. During the honeymoon phase, the remaining cells keep producing insulin. Once those cells die, your pancreas can’t start making enough insulin again. During the honeymoon period, you may achieve normal or near-normal blood sugar levels by taking only minimal amounts of insulin. You may even be in the normal range without taking any insulin. The target blood sugar ranges for adults with diabetes are: A1C: 7 percent A1C when reported as eAG: 154 milligrams/deciliter (mg/dL) preprandial plasma glucose, or before starting a meal: 80 to 130 mg/dL postprandial plasma glucose, or one to two hours after beginning a meal: Less than 180 mg/dL Your Continue reading >>
Diabetes Clinic
The Diabetes Clinic provides comprehensive care for children and adolescents with type 1 or type 2 diabetes mellitus, as well as other types of diabetes. Visit Schedule for Children Diagnosed with Type 1 Diabetes First visit: 1-2 weeks after leaving the hospital. This appointment is 3-4 hours. We want to make sure all is well with the diabetes management and adjustment, as well as the prescriptions. We will examine your child and answer any questions. Read our welcome letter for more information and what you should bring to the clinic. After your visit, please complete our Post-Discharge Diabetes Clinic Worksheet. Second visit: 1 month following the initial visit. Often the child is in or entering the honeymoon period, and adjustments and further education are needed (see below). Subsequent visits: Every 3 months; sooner if there are problems. In each visit a resident/fellow physician in training may see the child first, prior to the attending physician. A nurse, social worker and dietitian are available. Separate outpatient meetings with the dietitian or nurse alone are possible to book. The Honeymoon Period for Type 1 diabetes A few weeks following the diagnosis of type 1 diabetes, insulin doses are lowered, while maintaining excellent blood sugar levels. Is the diabetes going away? No! This is the honeymoon period, a period of excellent control, with very low insulin requirements. A few children may even be able to skip at least one insulin injection. The honeymoon period may last from a few months and up to a year or longer, depending on the amount of insulin-producing beta cells left in the pancreas. Therefore, children who are diagnosed early are less sick and without DKA usually have a longer honeymoon period. High blood sugar levels that are present prior to dia Continue reading >>
Newly Diagnosed: Doctors Answer Type 1 Diabetes Faqs
When your child is diagnosed with type 1 diabetes, it can feel like you have hundreds if not thousands of questions. The good news is that doctors have heard most of them before and can easily provide answers that will ease your mind. Here, doctors give the FAQs they hear most and share their responses. Q: What caused my child to get type 1 diabetes? A: “As a physician and type 1 diabetic myself, I understand the fears and concerns of parents for their newly-diagnosed children. Most people’s first question is what caused the diabetes in the first place. The truth is we don’t know for sure. Type 1 diabetes is considered an auto-immune disease where our immune system mistakenly begins attacking the insulin-producing (beta) cells of our pancreas. How could our immune system get so mixed up? One common theory is that the outer shell of a specific common cold virus looks very similar to the shell surrounding our beta cells in the pancreas. As our body eradicates this cold virus, our immune system may erroneously think our pancreatic beta cells must be more bad guys. From that time, it could take several weeks or even months before we begin developing the typical symptoms of diabetes. It wasn’t the basket of Halloween candy or the extra dessert — instead, it may have been a simple case of mistaken identity.” — Durant Abernethy, M.D., pediatrics physician at High Country Health Care in Frisco, Colo. Q: As a parent, did I do anything to cause the diabetes? A: “No! Parents can feel a lot of guilt if their child develops diabetes, and it’s important for you to realize and understand that you did not do anything to cause this disease. You are, however, one of the most important resources for helping prevent your children from developing some of the complications Continue reading >>
#18: The Honeymoon Period In Type 1 Diabetes
One of my blog followers, Svet, asked if there were ways to extend the “honeymoon” period in type 1 diabetes (T1D). The “honeymoon” is defined as the period of time shortly after the clinical onset of T1D in which a transient fall in insulin requirements occurs due to improved beta-cell function. It is believed to occur as a result of reduction in blood glucose (BG) with insulin therapy which in turn relieves “glucose toxicity.” Glucose toxicity is a term used to describe the effect of prolonged hyperglycemia on suppressing insulin production by beta-cells. The honeymoon period is a natural remission of T1D that is usually temporary, ending with a gradual or abrupt increase in exogenous insulin requirements within 3 years of diagnosis in most young children, especially those with the HLA-DR3/4 genotype. Total remissions (not requiring exogenous insulin) have been reported in 2–12% and partial remissions (requiring reduced exogenous insulin) in 18–62% of young T1D patients during the honeymoon period. Older age and less severe initial presentation of T1D and low or absent islet-cell antibodies have been consistently associated with deeper and longer remission. Destruction of beta-cells is much slower and often only partial in older patients, 15% of whom have still some beta-cell function preserved 10 years after diagnosis. Most studies agree that preserved beta-cell function is associated with better glycemic control (lower HbA1c) and preserved alpha-cell glucagon response to hypoglycemia. This study of 103 T1D children found that partial remission occurred in 71, being complete in three. The length of time until remission was 28.6 +/- 12.3 (mean +/- SD) days. The duration of remission was 7.2 +/- 4.8 months. They found that young age and severe disease a Continue reading >>
Remission In Type 1 Diabetes - What's New?
A number of factors promote to the occurrence of remission. Böber et al. conducted a retrospective study performed on patients diagnosed with IDDM [13]. In conclusion, history of infection prior to presentation and DKA at diagnosis was associated with young age and were the most important factors negatively influencing the remission rate in newly diagnosed IDDM patients. Knip et al. demonstrated that the boys had a remission more often and of longer duration than the girls. The children with remission had lower blood glucose, milder hyperketonemia and ketonuria, higher pH and PCO2 at onset than those without remission [14]. Swedish multicenter study showed remissions in 43% of the patients with a median duration of 8 months (range 1-73) [15]. In islet antibody-positive diabetes, normal body weight was the strongest factor for entering remission, whilst a low number of islet antibodies were of importance for the remission duration. Vetter et al. in the present study have used the HbA1c concentration at the time of diagnosis as an indicator of the duration of the remission phase in 23 juvenile diabetic children [16]. The results suggest that the initial HbA1c concentration may serve as a useful indicator to predict the duration of the remission phase in juvenileonset diabetic patients. Researches conducted in recent years indicate that the low prevalence of remission is observed in the youngest children, aged<5 year and in adolescents aged>12 year [17]. It is possible that the low frequency of honeymoon phase in young children reflect more aggressive β-cell destruction in young children. In adolescents insulin resistance contributes to less likelihood of having partial remission. Other authors have similar observations [18]. They asserted that young age and severe disea Continue reading >>
The Honeymoon Period.
So. You’ve just been diagnosed as a Type 1 Diabetic and there’s a lot going on. There’s a huge amount changing in your life and you may or may not completely understand what’s going on. I bet there is or has been a lot of terminology that’s been thrown at you. One of the phrases you’ll probably here is “The Honeymoon Period” or a variation of that. And then come the questions. What is it? Am I having one? Will I have one? How long will it last and how do I keep it going? Do I still need insulin? When will it end? Well, below, I’ve done my best to answer some of the most common questions. I hope it helps. What Is “The Honeymoon Period”? The theory of this, in basic terms, when you’re diagnosed as a Type 1 Diabetic your pancreas has initially given up, but then starts working again (this could be after a few weeks/ months) for a set period of time producing insulin (otherwise known as endogenous insulin) for their body to use as their pancreas starts to recover. Am I Having A Honeymoon Period? You’ll most likely find that if you are, the amount of insulin needed to be injected, pumped or whichever way it’s medically delivered (this is known as exogenous insulin) into your system will decrease in order to keep your blood sugars at a stable level. Essentially, your body will be producing enough insulin to decrease the need of amount of an external source. So How Long Can I Expect It To Last? Based on the evidence, it differs and it seems that little can be done in estimating. Some honeymoon periods only last a couple of weeks, others can last (like mine did) for 2 – 3 years. However, if your diabetes diagnosis is determined very early, the honeymoon can last for even longer. Talk to your specialist to see if there’s anything you can do to pro Continue reading >>
Is There A Way To Prolong The Honeymoon Phase For Type 1 Diabetes.
My 3 year old daughter was recently (6 weeks ago) diagnosed with type 1 diabetes. After the initial hospital stay, IV fluids and training for my wife and I about how to check BG levels and give insulin shots we have had to constantly adjust dosages down. So many lows, then highs, sleepless nights etc.. We were told initially about the honeymoon phase where her pancreas has recovered a little after initial treatment and is still producing insulin, be in insufficient amounts and seemingly somewhat sporadically. One of the first things that came to my mind was that I, as a parent, need to try and stop whatever is happening that is killing my daughters beta cells to preserve as much function as possible. However, it seems that most of the doctors that we talk to are just interested in the usual treatment plan. I read of a clinical trial that was done using Interferon alpha (I think this is an auto-immune suppressant which is used for HIV/AIDS, Hepatitis B and C) to prolong the honeymoon phase. Does anyone have any thoughts on prolonging this honeymoon phase? How long did yours last? I've read it's typically about 4 months to 2 years? Is there any hope for this? I don't want to drag my daughter through test after test or blood draw after blood draw, it's hard enough to get the finger pokes and injections but I also don't want to find out in a year or two or five that if I had done X,Y, or Z then I might have been able to stop to total destruction of my daughters insulin producing cells. thoughts? Continue reading >>
'the Honeymoon Phase' In Children With Type 1 Diabetes Mellitus: Frequency, Duration, And Influential Factors.
Abstract BACKGROUND: The honeymoon period (i.e., partial remission) of type 1 diabetes mellitus is characterized by reduced insulin requirements while good glycemic control is maintained. The clinical significance is the potential possibility for pharmacological intervention during this period to either slow down or arrest the ongoing destruction of the remaining beta-cells. METHODS: A group of 103 diabetic children, younger than 12 yr of age, were prospectively studied to assess the frequency, duration, and factors that may affect partial remission. At the time of admission, patients were characterized by age, gender, symptom duration, diabetic ketoacidosis (DKA), and blood sugar level at admission. The honeymoon period was defined as a period with insulin requirements of less than 0.5 U/kg/day and hemoglobin A1c (HbA1c) level of less or equal to 6%. RESULTS: Partial remission occurred in 71, being complete in three. The length of time until remission was 28.6 +/- 12.3 (mean +/- SD) days. The duration of remission was 7.2 +/- 4.8 months. Remission rates were higher in those patients older than 5 yr compared with those between 3 and 5 yr of age. DKA at presentation and long duration of symptoms were associated with lower duration of remission (p < 0.001 and p < 0.001, respectively). Children in whom remission occurred had significantly lower blood glucose levels and higher pH at presentation (p < 0.001 and p < 0.001, respectively). CONCLUSIONS: Young age and severe disease at presentation are associated with decreased residual beta-cells function that is reflected by a lower incidence of partial remission. These observations are important to consider in the research regarding therapies that will have the potential goal to induce prolonged and/or complete remission at di Continue reading >>
Partial Remission (honeymoon Phase) In Type 1 Diabetes Mellitus
Abstract Partial remission ('honeymoon') phase in type 1 diabetes (T1D) is characterized by a decline in the need for exogenous insulin that starts shortly after the initiation of insulin therapy in newly diagnosed individuals. In some cases, the insulin dose requirement is greatly reduced to almost none while maintaining near normal glycemic control. Results from the Diabetes Control and Complication Trial indicate that preservation of residual β-cell function is associated with not only reduction of long-term clinical micro-and macro-vascular complication but also reduction of acute complications such as hypoglycemia or diabetic ketoacidosis. There has been a recent renewed interest in partial remission because it offers a unique opportunity for pharmacological intervention aiming to completely arrest further destruction process of the β-cells, or best to regenerate the β-cells and thus preserve endogenous insulin secretion. This review summarizes current knowledge on partial remission in T1D, how to define partial remission by clinical criteria and C-peptide measurements, reviews factors associated with partial remission, and provides an update on the interventions to preserve β-cell function to promote or prolong the partial remission phase. Discover the world's research 14+ million members 100+ million publications 700k+ research projects Join for free Partial Remission (honeymoon phase) in Type 1 dose requirement is greatly reduced to almost none while maintaining near normal that preservation of residual β-cell function is associated with not only reduction of the β-cells, or best to regenerate the β-cells and thus preserve endogenous insulin to define partial remission by clinical criteria and C-peptide measurements, reviews in newly diagnosed individuals Continue reading >>
How Long Can A Diabetes Honeymoon Last?
When our six-year-old daughter, Bisi, was hospitalized last summer after being diagnosed with type 1 diabetes, part of the torrent of information we learned is that some patients have a diabetes honeymoon period, where the pancreas starts working again—though not perfectly—after diagnosis. The theory, in layman’s terms, is that the hard-working pancreas has given up the ghost, but then revives a bit after getting the rest that outside insulin injections provide. Not all people enter a diabetes honeymoon period, but the majority do; in one study of 103 children under 12 with type 1 diabetes, 71 had a honeymoon. Francine Kaufman, the chief medical officer at Medtronic Diabetes who formerly ran the Center for Endocrinology, Diabetes and Metabolism at Children’s Hospital in Los Angeles, explained that whether a child has a honeymoon and how long it lasts depends on “a combination of virulence of the autodestructive process and when in the course of the disease the diagnosis is made.” In the hospital, Bisi’s doctors told us that a honeymoon period could last for a couple weeks, or months, or up to a year. Very rarely, they emphasized—strongly—does it last longer than that, and the diabetes honeymoon, like all honeymoons, inevitably ends. Bisi started off at 4 units of Lantus a day—that’s one shot of slow-acting insulin that lasts about 24 hours in the background. She also receives Humalog, or fast-acting insulin, with her meals. In the hospital, to be conservative, they started her off at one unit of Humalog for every seventy grams of carbohyrates she ate. Over time, this ratio was adjusted downward, to a low point of 40 or 45 carbs per unit of insulin. Meanwhile, after some night-time lows, they adjusted her Lantus downward from 4 to 3.5 to 3 units a d Continue reading >>
Can My Honeymoon Phase Last Forever?
My husband and I just celebrated being married for five years and he is still the most amazing thing that ever happened to me. My honeymoon with him will never end. The ‘other honeymoon’ has to do with my recent ‘marriage’ to diabetes and the phase where your body is still producing a small amount of insulin to offset/support insulin injections. It is typically just a matter of time when this honeymoon ends. Diabetes may not be one of the most incredible things that ever happened to me, but despite it’s challenges, it is actually a very positive part of my life. It is almost exactly 4 months since I walked into the emergency room with my husband, feeling tired, lethargic, weak, thirsty and with a blood sugar level of close to 800 mg/dl. I still managed to keep a smile on my face as one medical professional after the other came by asking the same questions as the previous. Doctors couldn’t believe I was walking and talking (and smiling) – as I should have been in a coma, or even worse – dead. Our bodies are truly amazing and they often do things that can’t be explained, nor understood. Between our body and our mind, how could we ever doubt that we have what we need to live an incredible life – a healthy body, peaceful mind and happy soul? The problem is that we often take for granted, we expect, we doubt and we ignore what keeps us alive, healthy, happy and safe. The Honeymoon phase refers to the period of time shortly after type 1 diabetes diagnosis when the pancreas is still able to produce a significant enough amount of insulin to reduce (not stop) insulin needs and help blood glucose control. During the honeymoon phase, blood sugar levels are generally easier to control as the body still has some ability to help itself. Type 1 diabetes develops be Continue reading >>
The Honeymoon Period In Type 1 Diabetes
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 due to the absolute lack of insulin, such as increased drinking, increased urination, and weight loss. These symptoms are due to the body’s inability to transport glucose into the cells through the loss of insulin production. Glucose builds up on the blood and an increased amount of fluid is consumed to allow for its elimination and the cycle is perpetuated. Due to the loss of the energy efficient glucose/insulin pathway, fat is metabolized for energy using a less efficient pathway with production of ketones, which leads to the possibility of diabetic ketoacidosis. Keep in mind that in many children, teens, and adults with newly diagnosed diabetes, not all of the pancreatic islets have been destroyed. To exhibit symptoms of diabetes, approximately 80 percent of the pancreatic islets are either destroyed or non-functional. Therefore, 20 percent still may be remaining. After initiation of insulin, aerobic metabolism (the efficient energy pathway) is resumed and glucose may be transported into the cells and metabolized for energy. In anthropomorphic terms, the body “breaths a sigh of relief,” and normal metabolism can resume. After the body starts utilizing glucose and the high amounts of glucose bathing the islet cells in the pancreas (glucose toxicity) are decreased, the remaining islets may begin to recover the ability to produce insulin, resulting in the honeymoon period. This process does NOT occur in all patients and it sometimes takes several weeks to a month to start not Continue reading >>
Most People With Type 1 Still Producing Insulin
With new diagnostic tools, doctors can track the insulin production of people with diabetes who are long past the honeymoon period. If you have Type 1 diabetes and are out of the “honeymoon period,” you’ve probably been told that your pancreas has stopped producing insulin. But it turns out that information may be wrong. Many people with Type 1 still produce at least some insulin, even years after diagnosis. Traditionally, doctors and researchers believed that the pancreas “crashed and burned,” rapidly declining in its ability to secrete insulin as early as a year after the onset of Type 1. What new research now shows is that many people with Type 1 produce at least some level of insulin for decades after diagnosis.1,2 Your pancreas could be functioning for decades, not just one or two years after your diagnosis. In our study of nearly 200 patients who had been living with Type 1 for nearly two decades, we saw that C-peptide secretion (a sign of insulin production) decayed gradually over 20 years, and we were able to detect C-peptide in nearly two-thirds of the blood samples we analyzed. So, why did we think for so long that people with Type 1 don’t produce any insulin? And what changed? One major reason is that, until recently, we couldn’t detect the insulin being produced by people who long have had Type 1 diabetes, since they are producing C-peptide at lower levels than most current tests can measure. However, new ultra-sensitive blood tests for C-peptide are able to pick up very low levels of secretion, and they are now what we use in our laboratory for all of our Type 1 diabetes studies. Right now, the greatest impact of our ability to detect C-peptide will be on Type 1 diabetes research. Most Type 1 diabetes clinical trials have been directed at pati Continue reading >>
Vitamin D And The “honeymoon” Period Of Type 1 Diabetes
People newly diagnosed with type 1 diabetes may have a “honeymoon” period of partial clinical remission (PCR), during which insulin secretion normalizes and the body’s systemic inflammatory response diminishes. Past studies have found a link between vitamin D and these same markers of PCR – improved beta cell function and attenuation of the inflammatory response. This raised a question in the minds of endocrinologists at Nationwide Children’s Hospital: Would vitamin D supplementation increase the frequency of PCR in children and adolescents? A pilot study conducted at Nationwide Children’s and presented in June at the American Diabetes Association’s 75th Scientific Sessions found that it is possible, but larger studies are needed to reach clearer conclusions. “We saw a higher frequency of the honeymoon period in children receiving supplementation, but the difference did not reach statistical significance,” says Kathryn Obrynba, MD, an endocrinologist at Nationwide Children’s and the study’s lead researcher. “It might with a larger cohort.” The study followed 35 patients (median age 11.6 years) with new onset type 1 diabetes. One group of 17 patients took 3000 IU of cholecalciferol daily; the second group of 18 patients received a placebo. Both groups were assessed at three, six and nine months after diagnosis for PCR. The groups were also assessed at diagnosis and nine months for beta-cell function, systemic inflammation and 25-OHD levels. There was no statistical difference in PCR frequency between the two groups, but the frequency was higher in the supplementation group at every assessment: 88 vs. 69 percent at three months, 60 vs. 50 percent at six months and 33 vs. 14 percent at nine months. There were no statistical differences in inflamma Continue reading >>
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 pr Continue reading >>
