Can The Type 1 Diabetes Honeymoon Period Be Extended… Forever?
Diabetes mellitus (type 1 diabetes) is a condition where a lack of insulin production by the pancreas leads to hyperglycemia (high blood sugar), which can yield serious complications, especially in the long term. All patients with type 1 diabetes (formerly known as juvenile-onset diabetes) must currently take insulin for the rest of their lives once diagnosed, because the cells of the pancreas can no longer perform this production duty.
However, for many patients, there is a period of time after diagnosis and the start of treatment, where the disease is not apparent based on symptoms or blood sugar levels. Below we discuss this period, known as the “honeymoon period”, and how it affects those diagnosed with type 1 diabetes.
What is the “honeymoon period” of type 1 diabetes? When does it occur?
The “honeymoon phase” or honeymoon period is a period of time – generally soon after being diagnosed and starting insulin therapy – when the blood sugar levels are not yet elevated, and may even dip below normal (hypoglycemia). This is caused by the fact that in addition to the newly prescribed insulin regimen, a small percentage of pancreatic beta cells continue to produce their own insulin for a short time.
During this time, less insulin is needed, because the body’s own pancreatic cells are still operating to some extent. This diabetes honeymoon phase generally lasts anywhere from a few weeks to several months, though on rare occasions, patients have remained in this state for as much as 1-2 years. As the natural pancreatic cells remaining are destroyed or become dysfunctional, blood sugar levels and symptoms of the disease will gradually increase, which then requires an adjustment of the amount of insulin necessary each time it is given.
Are there any studies or clinical trials about how to extend this period as long as possible?
Yes, fortunately there appears to be a good amount of research taking place regarding the possibility of extending this period and preventing or slowing beta cell destruction. Many different approaches are being (or have been) investigated, including the use of antibodies directed at the T killer cells thought to be responsible for the disease, stem cell transplants and genetic rewiring of other pancreatic cells.
So far, results are mostly preliminary, but researchers are quite hopeful and are aiming to make a prolonged or permanent honeymoon period a reality for patients in the future. There has also been some early success inducing remission in those already suffering from type 1 diabetes. This is particularly true for children, as written up in this 2006 study, since most cases of type 1 are diagnosed in the pediatric population. While any solution would still likely require the inclusion of some insulin therapy too, blood sugar swings and disease symptoms could be much more tightly and effectively controlled.
One such study that was recently completed found that making a simple lifestyle change – in this case getting regular exercise – might also help extend the diabetes honeymoon period duration. Other research has investigated and continues to investigate various other aspects of the disease and its treatment, in terms of honeymoon period extension.
A clinical trial that will soon be recruiting participants is interested in examining the effect of vitamin D on disease parameters. An ongoing study is being conducted (though closed to participants) to try to determine which of two different insulin therapies works best to promote the diabetes honeymoon period. Another recently reported clinical trial examined possible reasons that the honeymoon period eventually ends, and how to use this information to induce a prolonged honeymoon phase.
Additional general information about past, present and future studies can be found at several websites, including NIH, ClinicalTrials.gov and CenterWatch.com. It is also a good idea to ask your doctor and/or contact your nearest major academic medical center to find out more about such trials.
What is the difference between medication to extend the honeymoon period and the diabetes vaccine that is in trials?
As is the case with any disease amenable to treatment, medications generally aim to treat or cure a disorder (including induction of the honeymoon period in diabetes), while vaccines are designed for either preventive or therapeutic purposes. The obvious benefit of vaccines over medication is that the former only requires one or several injections, while the latter necessitates treatments multiple times throughout the day.
The majority of current research appears to be focused on various medication approaches, such as those mentioned above, as well as improvements in traditional therapies like insulin and oral medicines. For example, this TrialNet clinical trial through University of Minnesota Amplatz Children’s Hospital aims to extend the honeymoon period in those recently diagnosed with type 1 diabetes and could help with treatment of other autoimmune diseases such as Addison’s and lupus.
While the ultimate goal of researchers and clinicians alike is the development of a universal vaccine for type 1 diabetes, and initial efforts look promising, it may still be a few years (or decades) before this becomes a realistic possibility in clinical practice. Among the research efforts are: use of a TB vaccine, and multiple studies to create a new type 1 diabetes vaccine, though another new diabetes vaccine was found not to work, both in the US and in the UK.
However, when such a creation is finally realized, it will be among the most important and massive breakthroughs in the history of medicine, benefiting millions of current and potential patients.
Questions for your doctor:
- What are your thoughts on new treatments for diabetes, and which do you think hold the most promise?
- Where can I find the best and latest information regarding this important area of investigation?
- Do you know of any clinical trials taking place for which I might be a candidate? If not, can you recommend any places to look, other than those listed above?
- How can I tell when my honeymoon period has ended, and what should be my next steps?
- Is there a difference in treatment success between those diagnosed in childhood versus adulthood?
About the Author
Dr. Rothbard is a professional medical writer and consultant based in New York City, specializing in medical education articles targeted at a variety of audiences, from children through clinicians. After leaving medicine, he worked as a biology and medical science educator for several years, before deciding to pursue writing full-time. He may be reached at firstname.lastname@example.org.
This blog post was originally published by AutoimmuneMom.com, written by Dr. Rothbard, and first published on Jul 12, 2013.
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