November 7, 2006
Question from Iowa, USA:
Should a person be treated with insulin during the honeymoon phase? I am in my 20s and very thin. My latest A1c was 6% and all my fasting glucose readings are between 100 mg/dl [5.6 mmol/L] and 124 mg/dl [6.9 mmol/L]. After meals, my readings are between 150 mg/dl [8.3 mmol/L] and 200 mg/dl [11.1 mmol/L]. I have had only two readings, usually before lunch, below 100 mg/dl [5.6 mmol/L] in the past two months. Is that normal?
I am an athlete and I want to be sure that I am healthy enough to participate in the upcoming competitive season. I’m having trouble gaining weight despite eating a lot and I’m often tired. I’m 5 feet, 8 inches and weigh 100 pounds. Am I really in the honeymoon? Could I not really have diabetes? Should I be on medicine to help “give my pancreas a rest?”
The honeymoon phase results from the resumption of the surviving insulin-producing cells making insulin. Unfortunately, the same process that destroyed the original cells end up destroying the remaining insulin-producing cells. Some people think that giving insulin rests the beta cells and make them less likely to be attacked by the body’s immune system. However, I do not think that is necessarily true and has not been documented. Many times, when people take insulin, they have recurrent low blood sugars and that is not good either. I tell my patients that the smallest amount of insulin to keep blood sugars in the target range is the way to go. It has been shown that patients with the best glucose control during the honeymoon phase have the longest honeymoon phase. Some may have a marked decrease in insulin requirements but may not get off insulin altogether. If you had marked elevation in blood sugars, it is unlikely that the diabetes will just go away, although I wish it would.