Honeymoon Phase
| Author: Judy Kohn, RN, BSN, CDE |
| Last Updated: Friday, March 31, 2006 |
Q: "My son, age 20, has been diagnosed as having Type 1 diabetes. Soon after beginning to take insulin shots, he reported that his blood sugar dropped dramatically—in the 40s & 50s every morning after taking the shots. He then stopped taking insulin, but continued monitoring his blood sugar. It remained in normal ranges for a week. He even drank a non-diet soda with seemingly no reaction. Is it possible his diabetes was temporary and that he no longer has diabetes?"
A: No, the diabetes is not temporary. After you read the following explanation, it is very important that your son call his doctor to discuss this with his diabetes team right away, so that they can assess his particular situation and manage the condition appropriately.
If your son was officially diagnosed with Type 1 diabetes, (i.e. either because he was in ketoacidosis, and/or the diagnosis was confirmed with a c-peptide test), then he could be going through what is commonly described in diabetes as being in the honeymoon phase. This is a "temporary grace period" that occurs in some young people--although not all-- usually soon after the diagnosis of diabetes and often within two to eight weeks. During that time, there is still some insulin being made in the islet cells of the pancreas. The honeymoon phase occurs less frequently in younger children, and it is more common in the late teenage years and in adults.
The "honeymoon" usually lasts a few weeks, but in some cases it has lasted up to a few years. During that time, the body may not need any extra insulin at all, but after this period the body will again require more insulin.
According to the American Diabetes Association's (ADA) Medical Management of Type 1 Diabetes, 3rd edition, evidence suggests that this phase might be prolonged if the blood glucose levels are kept to as near normal as possible. In fact, studies have indicated that early and aggressive treatment of Type 1 diabetes--i.e. achieving and maintaining blood glucose levels in the ideal range--can preserve some of the beta cell function for awhile, thus sometimes prolonging the honeymoon phase, as well as making the diabetes temporarily smoother and easier to manage.
The ADA book recommends that there should be no attempt to reduce insulin to the lowest dose possible nor to discontinue insulin, but instead, to give the highest dose needed to maintain normal glucose without causing hypoglycemia. Consequently, many experts still continue having the person inject a small dose of insulin--even if it is 1-2 units/day, to impress upon them that this diabetes is not going to disappear, to keep them in the habit of giving daily injections, as well as to maintain ideal glucose control.
So unfortunately, Type 1 diabetes does not ever completely go away, and this is only a temporary vacation from diabetes--hence the term "honeymoon." Experts advise the person to continue daily glucose monitoring, with special emphasis during times of growth, illness, or stress, which can increase the blood glucose as well as the need for more insulin. In fact, during an illness or stress, the honeymoon phase could come to an abrupt halt, thereby increasing the risk of ketoacidosis if insulin isn't quickly and adequately given.
Not fully knowing your son's condition, I should add that sometimes young people are mistakenly diagnosed as having Type 1 diabetes when they actually have Type 2 diabetes. You can read more about that in the Joslin Diabetes Center link below. Regardless, the diabetes still exists-but in the case of Type 2 diabetes, the person may be able to be controlled by diet and /or oral agents, although eventually many people with Type 2 diabetes will require insulin as well, over time. So if your son is experiencing this temporary honeymoon period, I want to emphasize how important it is to monitor closely; then, as soon as the glucose begins to rise again, the appropriate insulin dose can be given to prevent ketoacidosis and to quickly achieve and maintain the best diabetes control possible.
Related Links
Joslin Diabetes Center
http://www.joslin.org
Juvenile Diabetes Research Foundation (JDRF)
http://www.jdrf.org
American Diabetes Association
http://www.diabetes.org
Important Notice: The responses provided by the team of Diabetes Educators are based on their personal experiences and expertise as practicing diabetes healthcare professionals, and are not to be considered diabetes management advice from Abbott Laboratories. Remember that information provided by the team of Diabetes Educators is for general background purposes and is not intended as a substitute for medical diagnosis or treatment by a trained professional. You should always consult your physician about any healthcare questions you may have, especially before trying a new medication, diet, fitness program, or approach to healthcare issues.
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