Is honeymooning a good thing?

I read 2 replies on a previous post that refers to honeymooning as a good thing and as something that hopefully goes on a long time.

My idea of honeymooning is quite different. Please let me know if I am wrong.

Here are my thoughts.

With honeymooning, your pancreas has a few islet cells still producing insulin. If you dose with insulin externally and you produce it naturally, it seems to me that there would be less BG control since you have a known (external dosing) and an unknown (islet cells). How can you control your BG if you have no control over what the islet cells are producing?

When you are out of honeymoon, you need all your insulin externally which gives you more control since you know exactly how much you will need, knowing that your body does not produce any to throw your numbers off.

Is my rationale correct?

 

For us, the honeymoon did make things more unpredictable since you never knew if and when the the pancreas would help out a little.

Now that she is out of the honeymoon, it is still hard if not harder. She gets stubborn highs that were not as hard to deal with when she was honeymooning.

 

hmm I've been wondering this too now after that previous thread... I've thought that the added factor of extra unpredictable insulin would only make things more difficult, but then again it probably isn't called the 'honeymoon' period without good reason, and after the previous post I'm wondering if this isn't the case... Is it really only going to get harder after the honeymoon's over??? Why is this?

 

My son was diagnosed about 6 years ago. Our experience with the "honeymoon stage" was just a very gradual increased need for insulin (usually a two steps forward, one step back kind of thing). It lasted about 2 years, until he was finally close to the doses one would expect given his size and weight (thus indicating that his honeymoon was over).

During that time, we experienced highs and lows as expected. After the honeymoon ended, we got more extreme highs and lows. Honestly,I think we only saw a number in the 300's five times or less those whole first two years. Unfortunately, now we see those high numbers on a much more frequent basis.

Of course, I also must admit that we are probably less vigilent than when he was first diagnosed. He does much more of his own d care since he is 14 now, and occasionally forgets to bolus, which is a definite reason for many of the highs we see now.

That's just our experience...everyone is different.

 

IMO, it is good, because:

The unpredictability of the pancreas putting out insulin is infinitely easier to deal with the unpredictability (in BGs) of a pancreas that puts out no insulin at all.

I have no idea why anyone says the honeymoon made things hard, I suspect their experiences were just vastly different than mine. When the honeymoon ended keeping the BG's near range (not even IN range) became harder by a few orders of magnitude. And it was instant - it all come crashing down in a few days. No gradual exit for us, Alex's basal went from 4u to 10u.

If you ever know exactly how much insulin you need with 100% certainty after the honeymoon ends, give me a phone call. I'll hire you for $100K a year to be our CDE.

 

IMO, when honeymooning is "good" ...well, it does the adjusting for you. This means that you are injecting less basal and bolus insulin...but the body is making up the missing insulin. Keeping numbers in range more easily without have to dose insulin more exactly. Hope this makes sense.

 

I think it was easier during the honeymoon because a lot less insulin was needed, so there was less likelihood of a serious error. Once you go from a fraction of a unit per hour to several units per hour, the stakes are much higher. Also during growth periods basal needs can vary dramatically from day to day.

The honeymoon is good no matter what, because for as long as natural insulin is produced, the body is operating closer to a normal state. Natural insulin also includes c-peptide, which is thought to be a factor in reducing complication risk; external insulin does not include c-peptide. Anyhthing that can be done to extend the honeymoon should be considered. Keeping BG as close to the non-D range as possible is one approach, since higher BG levels accellerate beta cell death. We controlled BG close to a non-D range starting 3 months after DX (when we got our CGM), and the honeymoon lasted around 2 years which is a little longer than average. No matter what the immune system always wins though!

 

Well, as you will hear, your diabetes may vary- YDMV.

For us we were part of the group where the honeymoon was a good thing.

1) Feel good reason: It felt good knowing that her body was still making some of its own insulin - especially because it means she was still making c-peptides, which they suspect are protective against complications.

2) A1Cs under 6 always feel good.

3) "Highs" were under 200, and waking numbers were usually close to perfect (with out us bending over backwards to figure this out).

4) We also thought of the insulin we were injecting as being very "forgiving" since we knew her body could STOP putting out its insulin if there was too much insulin in the system, making bad lows less likely. So, our injections just needed to be in the ball park, and her body did the fine tuning.

5) By keeping bg as close to in range as possible, it will extend the honeymoon, since high bg is toxic to the remaining beta cells. And, the closer to normal you are able to keep bg, the easier it will be to keep it close to normal since the pancreas will not be over stressed, (and perhaps less likely to do random things).



However, remember, YDMV - especially if you have a young one with D, since with little ones' honeymoons are notoriously short or non-existent. :cwds: (Unlike with older people who get D past puberty, the chance of having a longer honeymoon is better since they are more likely to have had a longer onset (slower rate of the beta-cells destruction).

Anyway, good luck!

p.s. while I was composing this, I see four others posted much more concisely, ahead of me** - love this site!

 

Oh dear... that makes sense, but it's a bummer
As our highs are more like 400, and getting more highs like that all the time (and lows as low as 30), it's probably not helping to prolong his honeymoon at all!! A month ago I would have freaked at numbers like that, but despite my efforts it's becoming more common...

 

If you're seeing ever more frequent 400s, it's time to make changes to the insulin regimen.. :cwds:

 

Your a smart guy! You will get different opinions, but I think it's easier in some ways to just get down to business w/o help from the pancreas. Seth didn't have much of one anyway, if he had one at all...:cwds:

 

We thought the same thing. I think the grass is greener . . . that type of thinking. It would make sense that it would be easier to regulate after the honeymoon, but that is not at all how it worked for us. Despite the unpredictability, our dd's #'s were much easier to control when she was honeymooning than they are now. Everyone is different.

 

While we are on the subject, how do you know when the Honeymoon is over?

 

I certainly believe it is much easier to have the backup system (natural production) in place. I can put ds to bed with bg anywhere between 6-10 and know that he will wake up in the 4-6 range with no insulin on board and just a small basal (4u Lantus) I do not have to test in the night. The natural production is also adjusting for my bolus errors. It is true that it is much harder to know your carb/insulin ratios but it is much easier to maintain a lower A1C during honeymoon and that to me is the determining factor of which state I prefer to be in.

 

She only had the slightest of honeymoons. But those remaining beta cells, however few, helped prevent postprandial spikes (she could eat cereal, anything), rarely rose above 200, and her A1c was in the fives. Actually the high postprandial spikes did not start until a year post-dx. I still have good A1cs, not in the fives, though. And I often will see numbers over 200. Even if it is more difficult to manage regarding lows, I would have done anything to keep her in her honeymoon as long as possible. Unfortunately, I had not heard about Diamyd (I assume trials were available four plus years ago) and we wasted our time trying to get into Herald's study. She was denied and very shortly after out of honeymoon. Endo would prefer to keep them in honeymoon period as long as possible.

 

I think it depends on what your child experiences as a honeymoon.

Here are some scenarios, all of which are sometimes termed "honeymooning":

1) your child has almost no need for external insulin and his body self regulates; very few highs and lows are seen
2) you child has need for about half external insulin and half is done by his body; many highs, many lows
3) your child has only minimal insulin production but at random times; often lots of lows as the insulin production is not expected when it happens.

In cases 1, the honeymoon is just that - a very nice happy place where things just sort of work well. Many of us don't ever have that sort of honeymoon. Or, in our case, my son had a nice period 6 months after dx like this. I thought "ahha..this is what is so special about the honeymoon".

In cases 2 and 3, I, like you, I find it infinitely harder to deal with because you just never know what to expect from a pancreas that is unreliable and faulty and produces insulin whenever it feels like it - oh like just after you've given a meal bolus. LOL.

The other thing about honeymooning, and insulin production for a long time, is that it seems that the longer we can prolong insulin production the greater chance of islet recovery down the line - and they're finding that many people with long term diabetes and no complications often have some residual insulin production. So it seems important to some how protect those last few beta cells.

 

We got higher A1Cs after Hannah left the honeymoon, but far fewer lows, and everything was more predictable. I cried when I realized the honeymoon was over, but it is a lot less scary without unpredictable lows. I prefer being out of the honeymoon, and working to lower her A1Cs by being braver about putting her to bed with lower nighttime numbers.

 

Calculate the TDD for the last few days. Total insulin, basal and bolus. Average it out over however many days you pick. I usually do 3 days.

0.5u per kg in bodyweight in TDD is remission, aka honeymooning.
0.8-1.2 per kg is normal.

For example, for my son is 50 lbs:

50 lbs. is 23 kg
Remission TDD: around 11.3u (aka "honeymoon")
Typical TDD: 18.1u to 27.2u
Typical BCR: 8.0 mg/dl per g (0.44 mmol)​

When he was honeymooning his TDD was 2u at the deepest part, about 8u at the endpoints (dx and the end). Now he's definitely in the typical range.

 

I agree with much said so far.

I think a honeymoon is aptly named. It's a time of transition and for the most part it's easier to manage the numbers while you're getting your "D legs". It's also easier to get a pretty good A1c without killing yourself. So you gain confidence and usually positive encouragement from the endo.

In theory it should be simpler to dose once the islet cells really give up, but in fact, because so many factors effect bg - things that are difficult to predict and impossible to measure - it really isn't any easier - but YDMV. :cwds:

 

I chose Dr Herold's study hoping to extend Hanna's honeymoon, but I think it didn't happen. She is pretty clearly out of it given her last MMT test.