My daughter has been going through the honeymoon period for about two months with no insulin injections. I know this is common. I was wondering if a complete cure from type 1 diabetes is possible and if complete natural recovery has ever happened?

My wife often advises her clients (and our children) to “don’t ask questions you don’t really want to know the answer to.” I think you may have just asked one of those questions.

First of all, while a diabetes honeymoon is indeed extremely common, I think it is generally uncommon that the child can come off ALL insulin completely. In fact, I think it can be quite problematic in the long run.

During the honeymoon, the pancreas has gotten a bit of a “second wind” and does indeed make insulin more effectively. Why does this happen? The answer is not clear and there are several possible explanations. Regardless, during this time, the pancreas IS making more insulin and thus is working, probably hard. Thus, we sometimes say that it is at higher risk of “burning out” sooner, at which time the honeymoon will end, quickly and probably abruptly. At that point, the “easy” care of diabetes ends (“the honeymoon is over”) and glucose levels will be much harder to regulate unless there is careful attention to insulin dosing, meal planning, and exercise.

The longer the honeymoon lasts, the relatively easier it is to keep glycemic control relatively good. So, during the honeymoon, we advise typically to be certain to follow the meal plan, exercise, and take insulin. Sure, the insulin requirements might come down some, maybe even substantially, but only rarely have I been able to get a child off insulin.

Assuming that autoimmune infiltration of the pancreas is the cause of your child’s type 1 diabetes, your honeymoon is no cure, but a source of hope that will most probably be met with disappointment later. I am unaware of ANY documented “cure” of classic type 1 diabetes. I have certainly seen folks get quite lazy about the honeymoon only to be frustrated about the poor control later. They say something like: “We’re not doing anything different. How come the diabetes is so hard to control?” My response is along the lines, “Yes, the reason is that you indeed are not doing anything different. Perhaps you could have been more vigilant about meal planning and insulin dosing before. The diabetes is now different; you’re out of the honeymoon.”

If your daughter has been followed for her diabetes only by a general pediatrician, you may wish to ask for a referral to a pediatric endocrinologist. There are several that work through the excellent children’s hospital in your state capital. That group used to do several “outreach clinics” throughout your state. They probably still do.

DS