The honeymoon period for patients with Diabetes mellitus type 1

Diabetes mellitus type 1

Diabetes mellitus type 1 is a form of diabetes mellitus that results from autoimmune destruction of insulin-producing beta cells of the pancreas. The subsequent lack of insulin leads to increased blood and urine glucose...

 is the period that often follows diagnosis and initiation of insulin

Insulin

Insulin is a hormone central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle....

 treatment. It is often suggestive of remission, but it is important to note that the two are unrelated - it is not a cure for type 1 diabetes. During this period some of the insulin-producing beta cell

Beta cell

Beta cells are a type of cell in the pancreas located in the so-called islets of Langerhans. They make up 65-80% of the cells in the islets.-Function:...

s of the pancreas have not been completely destroyed yet and produce unpredictable amounts of endogenous insulin. This period does not occur in all patients. If the honeymoon period does occur, it lasts for varying lengths of time and can affect diabetics differently.

Importance of Insulin Therapy

When patients are first diagnosed with Type 1 diabetes, they are immediately started on exogenous insulin injections to control their blood sugar

Blood sugar

The blood sugar concentration or blood glucose level is the amount of glucose present in the blood of a human or animal. Normally in mammals, the body maintains the blood glucose level at a reference range between about 3.6 and 5.8 mM , or 64.8 and 104.4 mg/dL...

s. Patients who experience a honeymoon period will notice that they experience hypoglycemia

Hypoglycemia

Hypoglycemia or hypoglycæmia is the medical term for a state produced by a lower than normal level of blood glucose. The term literally means "under-sweet blood"...

 (low blood sugars) due to some of their own endogenous insulin working additively with the injected dose (calculated by their endocrinologist, usually as a carbohydrate-to-insulin ratio for each meal). Since this honeymoon period does not last forever, rather only for a short period of time, over time patients will notice fewer lows as their residual beta cells lose function. Eventually, the possibility for hyperglycemia

Hyperglycemia

Hyperglycemia or Hyperglycæmia, or high blood sugar, is a condition in which an excessive amount of glucose circulates in the blood plasma. This is generally a glucose level higher than 13.5mmol/l , but symptoms may not start to become noticeable until even higher values such as 15-20 mmol/l...

 (high blood sugar levels) arises due to the complete inactivity of their beta islet cells. At this point, patients will have to adjust their insulin-to-carbohydrate ratios.

It is important to maintain insulin therapy

Insulin therapy

Insulin therapy is the treatment of diabetes by administration of exogenous insulin.Insulin is used medically to treat some forms of diabetes mellitus. Patients with Type 1 diabetes mellitus depend on external insulin for their survival because the hormone is no longer produced internally...

 during the honeymoon period. Immediately prior to diagnosis, diabetic individuals have excess glucose in their blood that their tissues are not able to absorb but which decreases the activity of any viable islet cells in the exocrine pancreas

Exocrine pancreas

The exocrine pancreas has ducts that are arranged in clusters called acini . Pancreatic secretions are secreted into the lumen of the acinus, and then accumulate in intralobular ducts that drain to the main pancreatic duct, which drains directly into the duodenum.Control of the exocrine function of...

. This is commonly believed to be caused by a phenomenon called glucose toxicity but current research also suggests a major role of the immune system.. Once insulin therapy is started, the excess sugar inactivating the beta cells is removed and remaining viable beta cells produce and release some insulin throughout the honeymoon period. This period may last for weeks or months but not indefinitely and the amounts of insulin released are not consistent nor reliable to base exogenous insulin doses on. Type 1 diabetics, therefore, cannot eliminate regular insulin injections. It is also believed that injecting exogenous insulin daily at every meal allows the surviving beta cells of the pancreas to rest and this may allow viable beta cells can produce a small amount of insulin. Eventually, these viable beta cells will be destroyed, however and a complete insulin deficient state occurs. Therefore, if insulin injections are completely omitted during the honeymoon period, the possibility of the patient developing diabetic ketoacidosis

Diabetic ketoacidosis

Diabetic ketoacidosis is a potentially life-threatening complication in patients with diabetes mellitus. It happens predominantly in those with type 1 diabetes, but it can occur in those with type 2 diabetes under certain circumstances...

 is high.

Patience is Key

The honeymoon period may be a very frustrating time for diabetics since tight control of blood glucose levels is very difficult and ever changing insulin demands are required. To decrease the amount of lows experienced due to additional endogenous insulin production, their endocrinologist will re-calculate insulin dosages often via the insulin-to-carbohydrate ratio method. This is to accommodate for the extra insulin production but can happen on a weekly basis. Upon the completion of the honeymoon period, the patient will suddenly notice elevated glucose levels although insulin doses and amounts of carbohydrates consumed are kept consistent. Again, their doctor will have to adjust their insulin dosages accordingly (increasing the injection doses) and each time continue closely monitoring their glucose levels for a week or two, to observe how their body is reacting to the changing insulin availability (both exogenous and endogenous).

Length of Honeymoon Periods

The honeymoon period may last anywhere from weeks to months, and sometimes up to a year. Rarely will patients experience this period for prolonged lengths of time, more than a year. Unfortunately, there is no possible way to remain within the honeymoon period or to extend it. Diabetics must continue their prescribed insulin therapy as directed by their doctor to maintain normal glucose levels (4.0-10.0mmol/L) during and post honeymoon period. Big fluctuations in glucose levels (hypoglycemia and hyperglycemia specifically) may cause the honeymoon period to end sooner than if the glucose levels were tightly managed. Individuals who are diagnosed later in life, like teens and young adults, experience a longer honeymoon period than young children (early onset type 1 diabetes) because their beta islet cells lose function and are destroyed more slowly.

What Not To Do During a Honeymoon Period

It is very important to remember to not stop injections of exogenous insulin during a honeymoon period as it is not a case of disease remission, rather unpredictable residual insulin production. Patients must maintain a very tight grasp on their glucose levels and be in constant communication with their doctor, reporting all glucose levels (high, low, or normal), symptoms and steps taken to treat any hypo- and hyperglycemic events, as they need to deal with it accordingly. Never forget that the honeymoon period will come to an end eventually and a much tighter grasp on glucose levels as well as a more consistent insulin routine will be established.