My 10 year old relative has type 1 diabetes, and we don’t think she experienced a honeymoon. Does the fact that she had no honeymoon period make her diabetes worse? Could we have done something five years ago to avoid the onset of diabetes?

First of all, there is definitely nothing you could have done to prevent the diabetes. We are still looking for a way to prevent diabetes.

Normally, someone who doesn’t have diabetes makes about 1 unit per kilogram of body weight (approximately 1/2 unit per pound) of insulin a day. There is no precise definition of the honeymoon phase, but certainly if this child takes half of this amount or less a day, her pancreas is still making some insulin. We don’t really know why some children go into a prolonged honeymoon with very low insulin requirements, while others seem to have a partial, shorter lasting honeymoon, and others seem not to go into any honeymoon at all. We don’t even understand why the honeymoon occurs at all and would like to be able to prolong it. The honeymoon rarely lasts more than a year, though occasionally I have seen it last two or three years, if the child was diagnosed very early in the course of the disease.

Normally, the pancreas has to fail 50-90% before the blood sugar starts to go up. Some children are diagnosed very early when their blood sugar is just starting to go up. They may not even have any symptoms yet. They may be diagnosed through a routine yearly urine analysis. In my experience, those children usually have the most prolonged remission. Other children aren’t diagnosed until their pancreas has failed more. They may be diagnosed when they become very ill with DKA [diabetic ketoacidosis]. Although some of those children develop a prolonged remission, I find that it is usually shorter. In my experience, children who develop diabetes close to the onset of puberty or in early puberty often have no remission, or only a short partial remission. I suspect this may be due to the increased insulin requirements seen in puberty.

The most important thing is to get the best control you can (while avoiding too many lows). It seems that better control will prolong the production of a small amount of insulin by the pancreas. Even if the pancreas makes a very small amount of insulin, and this child needs approximately 1 unit per kilogram of body weight of insulin per day, control is usually easier.

TGL