March 6, 2005
Honeymoon
Question from Hillsborough, New Jersey, USA:
In August 2003, at age 26, I was diagnosed with type 1 diabetes. I had all of the classic symptoms and had lost a significant amount of weight (about 25 pounds) in a short time period, had extremely high blood sugars (too high for glucose meters to read), had an A1c of about 12.0, felt constantly tired, had blurred vision, etc. I met with an endocrinologist, was given an insulin regimen to follow, had follow up visits, and the diabetes quickly came under control with blood sugars never above 150 mg/dl [8.3 mmol/L] using a combination of NovoLog at meals and Lantus at bedtime.
About one month after my initial diagnosis, the amount of insulin I required began decreasing and, by about three months after my initial diagnosis, I required no insulin whatsoever to maintain fasting blood sugars about 100 mg/dl [5.6 mmol/L] and blood sugars two hours after eating below 140 mg/dl [7.8 mmol/L]. My endocrinologist told me that I had entered a honeymoon period and we would just have to continue blood sugar testing to see at what point the honeymoon would end. It is now a year and a half later and I still have fasting and post meal blood sugars as above without taking any insulin and none of the symptoms I had when I was initially diagnosed.
I don’t doubt the doctor’s initial diagnosis, but he doesn’t have an answer for me as to when this will end. I have exceeded his expectations for the length of my honeymoon period by about a year. I also have a brother with psoriatic arthritis, so autoimmune diseases aren’t uncommon in my family also reinforcing my belief in the initial diagnosis. Is there some measure of the probability for the length of the honeymoon period or is it really just a wait and see phenomenon with different doctors expecting different lengths based on their own anecdotal experience with their patients?
Answer:
You are fortunate to be able to discontinue insulin for this long. The duration of the honeymoon period does not rule out type 1 diabetes. It is thought that the honeymoon is dependent on the amount and activity of the residual beta cell population. These are the cells that make insulin in your pancreas. No more than 20 to 30% are left at the time of clinical diagnosis in patients with type 1 diabetes. You may have had more insulin-producing cells than usual. There may have also been a downturn in the autoimmune activity that destroys these cells, as well. I do not think a biopsy to look at islet cell mass is appropriate. It is not part of usual clinical practice. Rather, it is more common to measure surrogates of islet cell function, such as C-peptide response to a mixed meal challenge or oral glucose challenge test. The best way to maintain the honeymoon period is to make sure that mild degrees of hyperglycemia are treated. For this reason, you should probably not give up glucose monitoring.
JTL
