Type 1 Diabetes: Understanding the Honeymoon Phase
Key takeaways:
- The honeymoon phase is a temporary period after a type 1 diabetes diagnosis when there are still functional insulin-producing cells remaining.
- Blood sugar levels tend to be more stable, and insulin needs may be lower during the honeymoon phase.
- The honeymoon phase is a crucial window of opportunity for diabetes education and support.
Type 1 diabetes occurs when the immune system attacks insulin-making beta cells in the pancreas. This immune attack happens over time and can be broken into three distinct stages based on blood sugar levels and the presence of type 1 autoantibodies that target beta cells.
Symptoms of type 1 diabetes usually do not appear until the third stage, when the majority of beta cells are destroyed. The honeymoon phase is a temporary period in this last stage, right after diagnosis, when there are still functional beta cells in the body. Though the honeymoon period can’t be reversed, it may be possible to prolong it.
The honeymoon phase looks different for each person, but typically lasts anywhere from a few months to years. Many factors influence how long the honeymoon phase lasts, including age of diagnosis, antibody positivity, sex, and body mass index (BMI). Not everyone diagnosed with type 1 diabetes will have a honeymoon phase, and for those who do, it is always temporary.
How does the honeymoon phase affect insulin needs?
Because there are still working beta cells left in the honeymoon phase, insulin needs might be lower, diabetes management can be less intense, and time in range may be higher.
The honeymoon phase usually occurs after insulin therapy is started. It is thought that lower blood sugar levels help the remaining beta cells work better and produce more insulin. This can lead to being able to reduce insulin doses.
However, this insulin reduction can also be challenging. For example, an insulin dose might work at diagnosis, but be too much once blood sugar levels are back in range. After a few months, when the disease progresses, the same dose is no longer enough.
During the transition from the honeymoon phase to type 1 diabetes, your body is changing because there are fewer functional insulin-producing beta cells. Insulin needs tend to increase over time, and blood sugar management can be more challenging. This is not a reflection of how you are managing your diabetes. It can be harder because your beta cells are no longer able to produce enough insulin to meet your body’s needs.
Why is the honeymoon phase important?
A type 1 diabetes diagnosis can be overwhelming and involves a steep learning curve. The honeymoon phase can give newly diagnosed individuals time to receive education and support on diabetes management, as it’s a period when blood sugar levels tend to be more stable compared to later.
After diagnosis, keeping blood sugar in a target range puts less stress on these remaining beta cells, which can protect them longer. This also offers a window of opportunity for therapeutic intervention. Ongoing research is focused on therapies that can preserve remaining beta cells and delay disease progression, help with blood sugar management, and prevent long-term complications.
Can you extend the honeymoon phase?
Though the honeymoon phase eventually ends, studies have shown that physical activity can help stabilize blood sugar levels and may prolong the honeymoon phase. With some preparation, exercising with type 1 diabetes after diagnosis can be manageable and potentially protect functioning beta cells.
Several disease-modifying therapies are being studied to delay the onset of diabetes, effectively extending the honeymoon phase. Ideally, therapeutic intervention occurs before the honeymoon phase, but clinical diagnosis typically occurs when symptoms are present, and most of the beta cells have already been damaged or destroyed.
The disease-modifying therapies in research have not yet been approved by the FDA. They typically target the immune system or beta cells. A few of many ongoing trials include:
- Baricitinib: This is an immune-modifying drug used to treat rheumatoid arthritis and hair loss. In a recent clinical trial, baricitinib was found to preserve beta cell function in people with type 1 diabetes.
- Verapamil: A drug used for high blood pressure, verapamil blocks a pathway that triggers cell death. In a clinical trial, verapamil helped slow beta cell decline in people with type 1 diabetes.
- Vitamin D: There is a link between vitamin D deficiency and type 1 diabetes. While there is some evidence that vitamin D can help with beta cell survival, clinical trial data are inconclusive. However, given its low toxicity, vitamin D supplementation after diagnosis could offer some benefit.
- GNTI-122: This is a cell therapy that rewires a person’s own cells to fight the immune attack that happens during type 1 diabetes. There is a phase 1 clinical trial currently recruiting adults with recently diagnosed type 1 diabetes.
Looking forward
Therapeutic intervention can be more effective when given at an earlier stage of type 1 diabetes, making screening an important future endeavor. Early screening can also decrease the risk of diabetic ketoacidosis, a life-threatening emergency that can lead to severe complications. Countries like Italy, Germany, Sweden, and the U.K. have started screening programs in children to try to catch diabetes at an earlier stage before symptoms appear.
The honeymoon phase can be like having type 1 diabetes with training wheels on; while blood sugar levels tend to be more stable, eventually the person will be fully dependent upon insulin. This period can be a window of opportunity to receive support, education, and time to adjust to a new lifestyle with diabetes.
Learn more about managing type 1 diabetes in the early stages here: