April 8, 2002
Question from Atlanta, Georgia, USA:
I was diagnosed with diabetes over eight years ago, and thanks to a machine called the Biostator, I am still making some of my own insulin. What is the longest documented honeymoon period?
I don’t know the answer to your question about the longest documented honeymoon, and I am uncertain if those types of data are kept. Someone may have a patient with a very long honeymoon, but if they never published the case, no one would know. I can add that the longest honeymoon I encountered was nearly four years in an early teen who was a typical boy: on the ball team, ate “real food”, etc. He did keep very active (worked on his father’s farm), and he was not a terribly creative eater so would eat very similar meals. He was very good (but not obsessive/compulsive) about his shots and meals, etc.
The Biostator is a very interesting device. You might want to read an article about the use of a Biostator to induce a honeymoon. See Shah SC, Malone JI, Simpson NE. A randomized trial of intensive insulin therapy in newly diagnosed insulin-dependent diabetes mellitus. N Engl J Med 1989 Mar 2;320(9):550-4.
Additional comments from Dr. Donough O’Brien:
In the last few years, a good deal has been learned about the many different forms of diabetes beyond the original concept of juvenile or type 1 and adult or type 2. In your case, I suspect that you are not a ‘honeymoon period’ record holder for type 1A (autoimmune), either the childhood or the Late-onset Autoimmune Diabetes of Adulthood form but that you have type 1B. This has an acute insulin dependent onset; but in about half the cases after a few weeks or months there comes a time when insulin and hypoglycemic drugs can be dispensed with. There seems nonetheless to be a continuing diminution of insulin production reserves that suggests that some day it will again be required. This is an uncommon form in Caucasian families but constitutes over 50% of new onset cases in African American and Hispanic families and its basis in molecular terms is not yet well worked out. The differentiation from type 1A is nowadays on the basis of an antibody test which was not all that commonly applied in the past.
There are other possibilities including the very occasional type 2 insulin resistant form of diabetes.
From a purely practical point of view, a specific diagnosis is not all that important because the objective of treatment is to maintain blood sugars as near to normal as possible with a minimum of inconvenience to lifestyle and the cost of the testing may be significant.