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Question:

From Lawrenceville, New Jersey, USA:

How long can the honeymoon phase last? My 17 year old son was diagnosed with type 1 in January 2006 and was discharged from the hospital on a MiniMed pump, which he continues to use. He has had two A1c tests since his diagnosis six months ago and they were both 5.7% (excellent). The endocrinologist calculated that he is only taking.6 units/kg of weight/day and the usual dose is 1 unit/kg/day. The endocrinologist concluded that my son is in the honeymoon phase and producing about 40% of his insulin requirements. My son also takes Nicomide (which has Nicotinamide) for his acne, something the dermatologist prescribed about six months prior to the diabetes diagnosis.

Does my son's excellent control mean that it will be this easy to control his sugars in the future? Or, is his own insulin production helping him to maintain such good control? He still has occasional, brief episodes of sugars as high as 225 mg/dl [12.5 mmol/L]. He still has some lows. But, the endocrinologist concluded he is not having too many lows despite the 5.7% A1c.

Is the Nicomide helping him to maintain his honeymoon? I know studies about this have been controversial. How long can the honeymoon phase last? His sugar was 795 mg/dl [44.2 mmol/L] when he was diagnosed. Lastly, if he can continue to maintain A1cs under 6% for his entire life, will he avoid complications?

Answer:

I would not hope to impugn the decision to start your teenager on inulin pump therapy from the beginning. There are certainly pros and cons for doing this. I think that, in general, the disadvantages outweigh the benefits for early insulin pump starts.

With that out of the way, the "typical" diabetes honeymoon lasts about 12 to 18 months. With wonderful attention to meal planning and exercise and insulin dosing (and a bit of luck), I've seen honeymoons last nearly four years on three (if not four) patients.

With poor attention to the diabetes regimen, the shortest I've seen is two weeks and others, just a couple of months.

So, why the discrepancies? (And this ties into my concern of early insulin pump use.) During the diabetes honeymoon, there is an easy risk for getting a bit lax in the prescribed regimen. You overeat the meal plan "just a little." You underestimate the insulin dose "just a little." But, the glucose levels are fine, so no harm, right? I don't think so. The patient's own pancreas must "make up the difference" and this contributes to the demise of the diabetes honeymoon.

I also think that patients then learn some bad habits when they allow the honeymoon to plug the gaps. Then, later on when the honeymoon ends (and ALL honeymoons end!), it can be frustratingly difficult to get things straightened out again.

DS

[Editor's comment: For information about A1cs and complications, please review our previous questions about Complications, BH]

DTQ-20060730231755
Original posting 2 Aug 2006
Posted to Honeymoon and Complications

  
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Last Updated: Tuesday April 06, 2010 15:10:08
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