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Is there an empirical rule to tell me when the Honeymoon is over?

Discussion in 'Parents of Children with Type 1' started by sszyszkiewicz, May 6, 2014.

  1. sszyszkiewicz

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    So I was wondering.....how will I know when the honeymoon is over?

    Its been 6 months. He get 6 units of Lantus. He has a 10 to 1 carb/insulin ratio. If we are a little late with the Lantus he goes high quickly.
     
  2. Sarah Maddie's Mom

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    If his TDD is more than .5u for every 2.2lbs of body weight then he's technically out of honeymoon (i'm 95% sure that's the standard definition).
     
  3. sszyszkiewicz

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    Is TDD the sum of Lantus and Humalog?
     
  4. Megnyc

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    Total amount of lantus and humalog used per day.

    One thing to keep in mind is that the .5 unit "rule" isn't a hard and fast rule for how much insulin production your kid has. My body makes absolutely no insulin and I use around .35u/kg. I know teens who still have a decent c-peptide who use over 1 unit/kg.
     
  5. sszyszkiewicz

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    I am asking these questions because I am trying to get some sense of the road ahead. Right now we have pretty decent control, but I am attributing that to the honeymoon. We dont see massive overnight spikes for example. I make sure he is between 120 and 150 at bedtime and he typically wakes up between 100 and 120. He gets a spike after breakfast (thank you Dexcom) but then gets back down by the mid afternoon. Using the 0.5 units per 2.2 pounds of body weight, we would be out of the honeymoon. He weighs 85 lbs. He is getting 25-35 units per day total depending on meals, but only 6 of that is Lantus. (85/2.2)*0.5 is about 19 units.

    Overall we are between 70 and 180 about 95% of the time, and I am happy with that, but I am trying to determine if I still have training wheels on or not.
     
  6. wearingtaci

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    I think the"more then .5 per kg"rule is really flawed. A child who eats a lot of carbs could still be honeymooning(by insulin production)and use a lot more insulin then that. For us,I considered the honeymoon over when pizza wasnt just another meal. When DD was first diagnosed we could just bolus for the carbs in a slice of pizza and expect good numbers. Now we have to extend the bolus and still hope the D gods are smiling on us that day
     
  7. Sarah Maddie's Mom

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    My advice is to approach D management only in the present. What comes will come and you'll adjust then. '-)

    On the honeymoon issue, you asked f there was an objective measure and I posted the general rule of thumb. That said I don't think the "honeymoon" should be looked upon as an "on/off" switch. In our case I can look back and see that the first 5 years were considerably less volatile than the ones that followed even though I'm sure that at the time I thought her honeymoon was over by a year after dx.
     
  8. MomofSweetOne

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    Do you think a large part of that was impending puberty?
     
  9. sszyszkiewicz

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    Should we be expecting the endo to tell us what if any residual insulin producing capability DS has remaining? I mean is it normal for them to do that glucose test to get the c-peptide production every so often? I am guessing not (they didnt do it for our 3 month follow up) but I thought I would check.
     
  10. hawkeyegirl

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    The bolded is enough for me to tell you that you are definitely still in the honeymoon. :)

    For us, we only had about 5 months in the honeymoon before Jack's insulin needs exceed the "honeymoon" level. So five "official" honeymoon months. But around 2 years in, everything went wonky, and at that point, everything just got harder. BG swings were wilder and more unpredictable, and being "off" on a carb count had much more dire consequences. And different kids need different amounts of insulin, but just so you have a reference point, but Jack's Lantus dose at age 4 right before we went on the pump was 8 units per day. So 6 units a day for an 11 year old is a pretty low basal dose - again indicative of honeymooning. (Jack is now 10, and gets 19.2 units of basal a day).

    I think the best way to know when you come out of the honeymoon is when you realize, "Hey, this is quite a bit harder than it used to be. I'm seeing a lot more variability." Of course with your son's age, it's going to be hard to tell the difference between the honeymoon ending and puberty.

    ETA: We have never been told Jack's c-peptide results. I don't know what I'd do with that information anyway.
     
  11. Sarah Maddie's Mom

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    Yes, no, maybe so. I've run the 5 year thing past a number of D moms and many do seem to see a shift after 4+ years.
     
  12. Megnyc

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    I don't think so but if you are curious I am sure you can get it added to whatever blood work you do next.

    I only know about it because the health insurance at my college requires a really low c-peptide to pay for a pump and supplies (basically to prove type 1 vs. type 2). A lot of the freshmen with type 1 even with long standing diabetes have trouble meeting the requirement.
     
  13. sszyszkiewicz

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    Thanks everyone. I hope the training wheels stay on for a long time.
     
  14. Mish

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    Most people generally don't end up getting c-peptide levels done, and I think the reason is that it really doesn't tell you a whole lot beyond a number. They basically assume that there is some residual insulin production early on, and then, there isn't. Knowing how much doesn't really help, because that production is sporadic at best, and you can't really change dosing based on that info. Today the pancreas is helping a lot. Tomorrow, maybe not so much. Tonight yes, tomorrow night no.

    Sarah's rule is pretty much the standard. Anything under .5u per kg of weight generally means he's still honeymooning. But anything under 1u per kg still could mean residual insulin production, especially in a boy nearing puberty. You're son is going to put on a ton of weight in the next 2 years and gain a ton of height, and with that his insulin needs are going to jump, tremendously. Regardless if it's honeymoon ending or puberty starting, it's all just part of the game. Don't stress about it, don't fear it, just deal with it when it arrives. :)
     
  15. joshualevy

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    I second what Sarah said:
    1. Approach D management in the here-and-now.
    2. The 1/2 unit per kilo is a general rule of thumb.
    3. End of honeymoon is gradual, not on/off.

    I don't think there is a fixed definition of honeymoon. It's an informal term. Here are two quotes that I got from clinical trial web pages:

    the honeymoon period is characterized by the presence of a functional reserve of β-cells that favours an adequate metabolic control and low insulin needs in order to control glycaemia

    honeymoon effect following T1D, that is by a normal transient insulin free interval occurring after disease onset in some patients​

    You can also read this abstract: http://www.ncbi.nlm.nih.gov/pubmed/16629716 which includes this definition:

    The honeymoon period was defined as a period with insulin requirements of less than 0.5 U/kg/day and hemoglobin A1c (HbA1c) level of less or equal to 6%.​

    This was a fun read, and it's only one paragraph:
    http://medical-dictionary.thefreedictionary.com/Honeymoon+Period

    If you want to read more about this, you might try this: (I did not read it.)
    http://care.diabetesjournals.org/content/32/8/1384.full

    Joshua Levy
     
  16. quiltinmom

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    I second this. I figured his honeymoon lasted about nine months, the end of which was signaled by nearly doubling his insulin doses over the course of a few weeks. But lately I'm finding things affect him differently...lows then highs from eating "problem foods" (if he forgets to do a dual wave bolus), more dramatic lows from exercise, etc. he was dx'ed sept. Of '09 so btwn 4 and 5 years in we are seeing these types of changes.

    Another guideline I haven't seen mentioned is the basal/bolus ratio. If basal and bolus are around 25/75 percent (25% of TDD comes from basal, 75% from bolus), likely there is still a honeymoon going on, but if they are about equal, likely it is over. Again, the amount a person eats will need to be factored in, but it can give you a better idea.

    Hope this helps!
     
  17. MamaC

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    My kid's honeymoon went on for years. At one point, two or three years in, maybe longer, the endo ordered up a c-peptide. I think that was the only time.
     
  18. hawkeyegirl

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    For what it's worth, I think generally the older the person when they are diagnosed, the longer the honeymoon, but obviously individual situations vary.
     
  19. sszyszkiewicz

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    I was just trying to get a sense of people's experience with the honeymoon, and when they knew they were out of it. I read about all these different experiences people have, the problems, the crazy swings, blood sugars rising during the night etc... and I am not seeing any of that. If anything he drops to between 90 and 110 each morning. So although DS needs a fair amount of insulin, I think his pancreas is still keeping him semi-regulated. So the training wheels are still on here, and as far as I am concerned, they can stay on for years. Every minute we keep it between the lines is a good minute regardless of how it is getting done.
     
  20. MomofSweetOne

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    You might want to start noting the age of the child mentioned. Looking back, 11 was easy (it didn't seem like it then because we were learning), but puberty has been hard. Really hard. Two years of different basals almost every day. Now we're getting more days at the same basal, but occasionally there are very fast drops like I'd never seen before and require tons of carbs to counteract. Asking parents here and learning that this stage has lasted about a year helps. We should be out of it soon. Maybe we already are; the last terrifying night was in January. My daughter is no longer honeymooning, but she does have some residual beta function yet.
     

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