Prolonged Honeymoon Period In Type 1 Diabetic Patient With Low Carbohydrate Intake
Abstract: Background: Type 1 Diabetes Mellitus (DM) is caused by a progressive autoimmune destruction of the beta cells of the pancreas. This destruction begins years before the clinical manifestations of the disease become apparent. In newly diagnosed type 1 diabetic patients, the natural course of the disease is often characterized by transient restoration of beta cell function following initiation of insulin therapy. This period, often referred to as the “Honeymoon Period”, is characterized by a striking fall in the exogenous insulin requirements while good metabolic control is maintained. A few cases have been described where patients remain healthy without any insulin for an extended period of time. Factors favoring this period include absence of diabetic ketoacidosis (DKA) at initial presentation, short duration of symptoms and older age at presentation. We report a 34 year old male patient who has been in remission for four years while he is maintaining minimal carbohydrate intake and exercising five times a week. Clinical Course:A 34 year old male patient presented with a one month history of fatigue, weight loss of 20 pounds, polyuria and polydipsia. He was diagnosed with Type 1 DM based on his initial weight, age and positive glutamic acid decarboxylase antibodies (GAD Ab) 0.43 nMol/L (Normal < 0.02 nMol/L). He was not in DKA. He was started on basal/bolus regimen of insulin on which his hemoglobin A1C (HbA1C) trended down from 14% to 6.3% in five months and he was taken off Insulin. Two months later his fasting glucose was 107 mg/dl with C-Peptide level of 0.9ng/ml (normal 0.8-3.1ng/ml). Two hours after ingesting 200 grams of carbohydrates, his glucose rose to 215 mg/dl and his C-Peptide was 5.6ng/ml. Over the next 3 years, he continued to keep his carboh Continue reading >>
Characteristics And Determinants Of Partial Remission In Children With Type 1 Diabetes Using The Insulin-dose-adjusted A1c Definition
Copyright © 2014 Aurore Pecheur et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract To evaluate the characteristics and determinants of partial remission (PR) in Belgian children with type 1 diabetes (T1D), we analyzed records of 242 children from our center. Clinical and biological features were collected at diagnosis and during follow-up. PR was defined using the insulin-dose-adjusted A1C definition. PR occurred in 56.2% of patients and lasted 9.2 months (0.5 to 56.6). 25.6% of patients entered T1D with DKA, which correlated with lower PR incidence (17.6% versus 82.3% when no DKA). In our population, lower A1C levels at diagnosis were associated with higher PR incidence and in young children (0–4 years) initial A1C levels negatively correlated with longer PR. Early A1C levels were predictive of PR duration since 34% of patients had long PRs (>1 year) when A1C levels were ≤6% after 3 months whereas incidence of long PR decreased with higher A1Cs. C-peptide levels were higher in patients entering PR and remained higher until 3 years after diagnosis. Initial antibody titers did not influence PR except for anti-IA2 titers that correlated with A1C levels after 2 years. Presence of 2 versus 1 anti-islet antibodies correlated with shorter PR. PR duration did not influence occurrence of severe hypoglycemia or diabetes-related complications but was associated with lower A1C levels after 18 months. We show that, at diagnosis of T1D, parameters associated with -cell mass reserve (A1C, C-peptide, and DKA) correlate with the occurrence of PR, which affects post-PR A1C levels. Further research is need 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 >>
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 >>
Effect Of Nicotinamide On Newly Diagnosed Type 1 Diabetic Children
Aim: To determine whether a low dose of nicotinamide (NA) therapy for pediatric patients with type 1 diabetes, initiated within the first 24 h of diagnosis, prolongs the “honeymoon” period and lowers their insulin requirements. Methods: All children (n=66) with newly diagnosed type 1 diabetes admitted to Salmaniya Medical Complex between 1998 and 2000, received NA 1-2 mg/kg per day, in addition to sc insulin bid. The patients were followed for 24 months (NA group). Findings in this group were compared with records from a similarly diagnosed control group (n=37), who were admitted to the same hospital between 1995 and 1997 and did not receive NA treatment. The insulin dose per kg bodyweight required at baseline and at 3-monthly intervals up to 2 years after diagnosis was determined. At baseline, the two groups did not differ with respect to age, ethnic background, weight, insulin dose per kg bodyweight or glucose levels on admission. However, NA group had lower insulin requirements than control group at each 3-month interval up to 2 years after diagnosis. Conclusion: Our study results suggest that even low doses of oral NA given to children with newly diagnosed type 1 diabetes may reduce insulin requirements and prolong the “honeymoon” period. Continue reading >>
Remission Phase In Paediatric Type 1 Diabetes: New Understanding And Emerging Biomarkers
Abstract Type 1 diabetes (T1D) is a metabolic disease of unknown aetiology that results from the autoimmune destruction of the β-cells. Clinical onset with classic hyperglycaemic symptoms occurs much more frequently in children and young adults, when less than 30% of β-cells remain. Exogenous insulin administration is the only treatment for patients. However, due to glucose dysregulation, severe complications develop gradually. Recently, an increase in T1D incidence has been reported worldwide, especially in children. Shortly after diagnosis, T1D patients often experience partial remission called “honeymoon phase,” which lasts a few months, with minor requirements of exogenous insulin. In this stage, the remaining β-cells are still able to produce enough insulin to reduce the administration of exogenous insulin. A recovery of immunological tolerance to β-cell autoantigens could explain the regeneration attempt in this remission phase. This mini-review focuses on the remission phase in childhood T1D. Understanding this period and finding those peripheral biomarkers that are signs of immunoregulation or islet regeneration could contribute to the identification of patients with a better glycaemic prognosis and a lower risk of secondary complications. This remission phase could be a good checkpoint for the administration of future immunotherapies. © 2017 S. Karger AG, Basel Type 1 Diabetes and Autoimmunity Type 1 diabetes (T1D) is a metabolic disease caused by the destruction of insulin-producing β-cells by the immune system. It is the commonest endocrine disease in children and adolescents , although it can appear at any age. T1D is preceded by a long asymptomatic period (prediabetes) in which immunological tolerance to β-cells is lost. The clinical symptoms Continue reading >>
The Diabetic Honeymoon Phase
The Diabetic Honeymoon Phase By: Camilla Roelants The Diabetic Honeymoon Phase. I often wonder who decided to call it that, and what on earth they were thinking. The word “honeymoon” evokes in me images of newly-weds, skipping along the beach, hand in hand under a glorious sun, beaming, happy faces, relaxed and care-free, their excitement at starting this new adventure together near palpable. Not the ugly reality of this particular honeymoon – the dying process of the islet cells of my pancreas, under auto immune attack, slowly but surely losing all ability to produce the insulin I need to live. Sixteen months into my Type 1 Diabetes honeymoon phase and I feel exhausted from it all. This time has been fraught with hurdles and worries and struggles. Despite having done everything in my power to gain control, blood glucose levels have been erratic. The dying beta cells in my pancreas occasionally and unpredictably produce a little bit of insulin, causing chaos where I have already bolused according to my insulin to carb ratio at mealtimes. I suffer frequent, sudden and terrifying episodes of hypoglycemia. I’ll be doing something very mundane – reading, cooking, or even just chatting to someone on the phone. When I suddenly realize that I’m feeling “off”. I usually can’t put my finger on it immediately – my brain is already starting to become impaired. I can’t think straight. I stop whatever it is that I’m doing. Mid-sentence, mid-shower, mid anything. I stumble, and mumble ” check levels ” to myself. At this point, I have eyes only for my meter. I put a test strip in. Prick my finger. I notice my hands are shaking. My five year old is asking me something. It sounds distant, although he’s standing right next to me, tugging at my T-shirt. “No 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 >>
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 >>
Ads by Google "Honeymoon" simply means the period just after the wedding when things are at their sweetest and slowly wanes in few months. Similarly, for some people with diabetes, the honeymoon period is cool with better blood glucose control and slowly wanes in few months once pancreatic beta cells are destroyed. For others, it might not be cool and fun. Instead, it is hot and boredom. In one study of 103 children under 12 years of age with type 1 diabetes, 71 had a honeymoon. Reference: Pediatric Diabetes 2006 Apr; 7(2):101-7. What is diabetes honeymoon phase? The honeymoon phase is the resurgence of the pancreas from autoimmune destruction. The honeymoon period among people with type 1 diabetes refers to the period shortly after diabetes diagnosis, when the pancreas starts producing a significant amount of insulin due to some recovery of pancreatic islet cells. It helps reduce insulin requirements and aid blood glucose control. During this honeymoon period, your blood-glucose levels may improve to normal or near-normal level. It is only temporary and does not indicate diabetes is recovering, improving, or cured. How to I know I am in honeymoon period? When you are in the honeymoon period, then your exogenous insulin requirement will drop drastically, and your blood sugar level suddenly starts maintaining within tight range say 80 to 150 mg/dl (4.4 to 8.3 mmol/l). How does honeymoon phase develop? When exogenous insulin lowers the blood sugars, your surviving beta cells wake up, and the Honeymoon Phase can begin. You know after t1d diagnosis, there is some undestroyed pancreatic islet cell. After insulin treatment, there is a decrease in glucose toxicity of islet cells. It facilitates the recovery of pancreatic islet cells and release of some insulin; this happens af Continue reading >>
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 >>
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 . 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 . Swedish multicenter study showed remissions in 43% of the patients with a median duration of 8 months (range 1-73) . 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 . 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 . 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 . They asserted that young age and severe disea Continue reading >>
New Diabetes Treatments Aim For Never-ending Honeymoon
Type 1 diabetes worsens over time – but like most marriages, it starts with a honeymoon. In type 1 diabetes the honeymoon follows diagnosis. The disease is caused by the loss of insulin-secreting beta cells in the pancreas. Type 1 diabetes can arise at any age, although it often is associated with youth. About half of cases arise in childhood or adolescence. The honeymoon, or remission phase, refers to the period following initial diagnosis when the remaining insulin producing beta cells are functioning well. During this honeymoon, it is easier to control blood sugars, with fewers swings, less risk for hypoglycemia, and lower overall average blood-sugar levels. Stephen Gitelman, MD, who leads clinical trials of new treatments for the UCSF Diabetes Center, would prefer to see the honeymoon never end. His goal is a marriage between newly diagnosed patients and new treatments that could keep type 1 diabetes under control forever. Gitelman, director of the UCSF Pediatric Diabetes Program, is enrolling patients in new clinical trials. Among them is a first-in-humans evaluation of a treatment in which a specific type of cell found in the patient’s own blood, will be removed, purified and grown up in the lab, and then infused back into the patient. “The idea of intervening in new ways at this early stage has really exploded,” Gitelman says. Since 2000, the UCSF Diabetes Center has rapidly accelerated the pace of research and clinical care in diabetes, including playing a significant leadership role in TrialNet, a research program dedicated to the discovery of new therapies to delay, or prevent, the onset of type 1 diabetes in at-risk individuals. Gitelman serves as UCSF's study director for TrialNet, a consortium of investigators from 18 of the leading diabetes institu Continue reading >>
Caroline’s Story: Overcoming Type 1 Diabetes With Real Food
Today, Caroline Potter from Colorful Eats, has an amazing story of recovery for you. She’s worked with the same nutritionist that I have these last few years, and has been able to treat Type 1 diabetes with a nutrient-dense diet and natural supplements. It’s another encouraging story of how food can play a significant role in our fight against disease! Treating Diabetes with Real Food Life in your 20s seems pretty grand. You feel powerful, youthful and energized. Dreams seem within your reach and challenges seem conquerable. Then out of the blue, college bliss turns into doctors offices and waiting rooms. Countless tests of all forms, vague results and no answers as to what was wrong with me. As I came home from college that winter for Christmas break, I laid on the couch for most of my vacation. I was constantly starving, eating everything in sight but quickly loosing weight. Finally, one day while out to dinner with my family, I broke down in tears because my mouth was so dry, I could barely talk. I was experiencing dry mouth, one of the major symptoms of diabetes. Diabetes? I was 20, a seemingly healthy young girl, who grew up in a home where my mother fed us all organic food. I was the one in school with her carrot sticks and tuna salad sandwiches. I never drank soda or ate Oreos, so the thought of diabetes was never even on my radar. Barely able to walk up a flight of stairs, I checked myself into the ER to discover my blood sugar levels were in a diabetic coma range. Later the next morning, the doctor diagnosed me with type 1 diabetes. I was scared, hopeless and confused. The days that followed were difficult to say the least. I still felt sick all the time, gained over 20 pounds in 2 weeks and felt terribly alone. My legs turned black and blue from giving mys Continue reading >>