Diabetes and the Honeymoon Phase

There is sometimes a period, right after the diagnosis of diabetes is made, when the insulin needs of the patient decrease after previously increasing.

This change may last anywhere from a few months to a year, and it is known to physicians as the "honeymoon period" or "honeymoon phase."

Type 1 Diabetes

Type 1 diabetes is an autoimmune disease. This means that the body's immune system attacks the beta (insulin producing) cells of the pancreas, killing them off. This may take some time, depending upon how aggressive the immune response is. Diagnosis of type 1 diabetes generally occurs when about 90 percent of the beta cells have been destroyed.

If the diagnosis of diabetes is made during a period when the patient is ill, there is an immediate need for insulin treatment. Likewise, if the diagnosis is made after all beta cells have been destroyed, insulin treatment needs to begin immediately.

On the other hand, if the infection has cleared or the pancreas still contains working beta cells, the need for insulin might be considerably less, almost giving the appearance that the type 1 diabetes has reversed itself. This is the honeymoon phase or the honeymoon period.

During this period, however good the A1c or blood glucose readings are, the disease is still present. It is still killing beta cells.

The patient should continue to take regular insulin injections, because stopping insulin means that the death of the beta cells can accelerate, and the patient will need to be on insulin - probably at a higher dosage level - when all the beta cells are gone.

Continuing low dose insulin treatment during the honeymoon phase may cause the beta cells to survive longer, because they are "relieved" of carrying the full burden of insulin production.

Type 2 Diabetes

A similar situation exists with type 2 diabetes, albeit for a different reason. When someone is diagnosed as being diabetic or pre-diabetic, they are encouraged to modify their diet and get more exercise. If the patient heeds this advice, their next A1c or blood glucose test could be substantially lower, perhaps even at normal, non-diabetic levels.

It would be a mistake to assume that this person is in permanent remission from diabetes; if the diet and exercise changes are not continued, the diabetes will come creeping back. In fact, if a patient who is enjoying their honeymoon phase were to eat a substantially large meal, their blood sugar would rise farther, post-prandial, than that of a non-diabetic.

Making dietary changes and getting more exercise are certainly beneficial to the diabetic. They will cause improvement to blood glucose levels. It is important to understand, though, that these actions will not cause diabetes to go into true remission.

Sources: Joslin Diabetes Center and Diabetes.co.uk

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