Can someone explain the honeymoon period?

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MarinaDE

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I was diagnosed 3c about five weeks ago now, and after the first week my doctor adjusted the medication. I've also adopted a mostly low carb diet. Since then, my blood has been completely in range and I feel for the first time like I just have to take the medication, inject the insulin every morning, and then forget about it, pretty much.

A friend of mine whose kids have Type 1 tells me I may be in the classic honeymoon phase, and that this may change and the diabetes may be much harder to control some time in the future.

Is this true? If so, is there a way to stave off the end of the honeymoon? Or is it an inevitability? (Or is it just the equivalent of a diabetic old wive's tale?)
 
The honeymoon period just covers the time when your remaining beta cells are dying off and so still produce some insulin erratically. As you’re 3c, the situation might be slightly different with regard to die-off. I’d also add that often the introduction of insulin injections takes the pressure off the remaining beta cells and they rally a bit for a while, making control easier. Early introduction of insulin can help prolong the honeymoon period. Keeping good control can too.

But yes, control generally gets harder once you’re out of the honeymoon and have no/little insulin of your own.
 
Type 1 is an autoimmune condition, our body gradually kill off the cells that produce insulin.
During that "dying off" period, the cells may come back to life temporarily which can make insulin dosing difficult to manage. But it does mean that at first, our body's natural ability to produce insulin will help the insulin we inject.
Over time, more and more insulin producing cells are killed off until, we are not producing any insulin at all, This is the honeymoon period.

With Type 3c, I do not know if you experience the same honeymoon period because the cause is different.
 
Hi Marina am sure others will make much more informed contributions but my understanding is unless you have had your Pancreas fully removed it may well still be producing some insulin hence your “ honey moon period”.
You may feel that not taking the extra insulin is good in some way but I look upon it as taking the pressure of the Pancreas to work hard to produce the insulin so effectively extending the honeymoon period.
I understand that eventually your Pancreas will stop producing insulin therefore you will likely need increasing amounts at some time in the future.
The question of insulin resistance also has sone part to play although as a Type 3c it is a similar to Type 1 so more a deficiency problem just with a different cause.
 
People seem to experience the honeymoon period in different ways. For some it rounds off the edges and buffers their levels and they have an easier time of it during this period and for others it makes things more erratic with home produced insulin turning up after you have injected and dropping you when you don't expect it. It was the latter for me and I am happier to be rid of it. That said, our bodies are constantly changing in their insulin needs due to a whole host of factors (about 42 of them), so from time to time our insulin needs change and we have to understand how to recognize whenwe need to change things and what to change and by how much. Initially our nurse tells us the doses we need to take on a best guess basis, but as we get more experienced and start to learn how our individual body works we learn to make those adjustments ourselves.
It sounds like you may be just taking basal insulin at the moment but not meal time insulin. There will likely come a time when you need fast acting insulin for meals too and then you need to learn to adjust your doses for each meal.

Early introduction of insulin can preserve those remaining beta cells for longer, so as mentioned by others above, injecting insulin, takes the strain off your remaining cells and that may well enable them to chug along for longer, so introducing a little meal time insulin now might help them out even more, if you are not currently using it and you are finding the honeymoon is smoothing the edges off things for you. As said, I am pleased to be rid of them as it just made things more difficult for me.
 
Hi Marina, the other responses have pretty well covered your question. Certainly not an old wives tale, but I loved the thought!

From what very little I can tell from dialogue with other T3cs as a result of their pancreatitis, the damage to their panc'y is extremely varied. We have at least one member on this forum who only needs oral meds, ie I deduce her panc'y is coping pretty well; another member who had a few years grace before becoming insulin dependent and at least one member who had to go for more surgery and surrender the rest of their panc'y. So one size does not fit all!

This is not so different from all of us diagnosed as diabetic and at least one T1 of long standing describes herself as effectively having no panc'y. T1s in general have many differences in detail; T2s even more so.

One thing, unrelated to your question, is that you may well find your insulin is 'going further' thanks to this spell of very warm weather (assuming its as warm in Germany as it is here). For most people, not authoratively everyone but most, warm weather reduces our natural insulin resistance so for your fixed amount of bolus (NovoRapid) it needs more carbs to stop it taking you hypo OR reduce your bolus doses. For Tresiba I'm currently not adjusting my basal, anticipating that the warm spell won't endure. If after perhaps a week AND I see that my overnight CGM graph is regularly (repeatedly) falling through the night and so lower in the morning THEN I will probably reduce my Tresiba from 9.0 to 8.5 units and monitor. That change could take 3 days to become effective, it might be apparent after 2 days.

Incidentally, I had a face to face consult with my D specialist yesterday and that lady was clear that taking my daily Tresiba in the morning rather than evening was good. I ran out of time to establish why (other things I wanted to ask).

Anyway hope you are well and your GP app't next Tuesday goes well. Which quarter of Germany are you in?
 
Hi @Inka @helli @Wendal and @rebrascora for all your answers. That's clarified things for me.

@Proud to be erratic you may have answered a question I've been having. My blood sugar has been in perfect range for days now, but although I haven't changed anything, I'm starting to get very short periods of hypos while I sleep and this morning I had a hypo alarm. I was wondering if my blood sugar was TOO well controlled, but maybe it's the heat?

I've been reading up and it may also be that I have wine with dinner and have taken to doing a vigorous one-hour walk every night. Apparently, alcohol and exercise (particularly in the heat) both affect blood sugar.

(I've been having this secret fantasy that maybe these dips mean I've been overmedicated, and I can throw the medication away and just do low carb forever, but your comment about the heat makes a lot of sense.)

I'm in the Pfalz. I had a blood test at the GP yesterday, where the medical staff are very unpleasant. I think it's a combination of my poor German and that I am a pushy patient - I asked for the blood test to include vitamin levels, as per my London endocrinologist's request and they were a bit outraged at being asked for something an overseas doctor had asked for. I told them I'd had a medical emergency in London and explained what it was, and the phlebotomist said it wasn't surprising because my February blood test had shown elevated sugar.

I was like WTF? I could have got this diagnosed a while ago, and not had to face sharply rising ketones in my blood and all the sickness that went with that? I wouldn't have had to cough up £2,500+ while on holiday? They saw an abnormal result and never told me? In most places, that's clear medical negligence.

It's been 24 hours and I'm still surprisingly angry about it, though my philosophy is to let things that can't be changed go. As soon as I get my Überweisungen for the various specialists I need (my testing in London revealed a potential heart problem, too), I am going to look for a new GP.

The good news is that it turns out there is a diabetes clinic literally two streets away, and their website says they specialise in rare forms of diabetes, so that's brilliant. I think a lot of the earliest research into 3c was done here in Germany, so it's the right place to be.

I may come back with some questions about navigating the system here! Your help would be much appreciated.
 
MarinaDE said:
My blood sugar has been in perfect range for days now, but although I haven't changed anything, I'm starting to get very short periods of hypos while I sleep and this morning I had a hypo alarm.
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If these are very short periods of lows and occur overnight, they are more likely to be compression lows - when pressure is applied to a sensor, it will report a false low. The reason I say this is more likely to happen at night is because that is when we could lie on our arm and squash the sensor. This could happen more in the hot weather because we don't sleep as well and toss and turn ... at least I do.

I am not sure if anyone shared with you the limitations of CGMs. As Libre is the most common one, these are often reported as "Libre limitation" but they are problems with physics, The only difference is how the manufacturers have chosen to deal with them.
Anyway, enough waffle, here they are with apologies if you already have this
- Some of us find that our bodies do not like have an alien object inserted into our arm. It take a day or two to "bed in" a new sensor. As a result, the first 24 to 48 hours after inserting a sensor could be more random. Some of us insert a new sensor the day before activating it to overcome this.
- Compression lows. Take care where you place your sensor and try to avoid the part of your arm that you lie on. If you get a low alarm in the middle of the night, check it with a finger prick before treating.
- "Normal range". GCMs are designed to be most accurate at "normal" BG. This is around 4.0 to about 8.0 and, if you see a value outside of this range, it can exaggerate the high or low. Again, the advice is to check with a finger prick before treating.
- Extrapolation. CGMs read interstitial fluid which will react to changes in BG about 15 minutes slower than blood. This is where I know some CGMs differ. Libre handles this by extrapolating the current trend to "predict" the current reading. If your trend changes direction in the last 15 minutes (e.g. when treating a hypo), the prediction could overshoot. Libre will correct this when it has "caught up". But at the time, it will seem like you are going higher or lower and taking longer to recover. Again, another reason for double checking with a finger prick.
- Faulty sensors. Not every sensor will be checked in the factory so there are some faulty ones in circulation. If you read social media, it will seem as if all sensors are faulty but human nature is to complain when things go wrong and say nothing if things are ok. The most common "fault" is inaccuracy. Therefore, it is a good idea to check the accuracy against .. .yes, you have guess it ... a finger prick. I tend to check once a day when my levels are stable and in that "normal" range I mentioned above. Don't expect exactly the same numbers (meter standards allow 15% inaccuracy and both could be out by 15% in opposite directions) but it is useful to give yourself confidence your current sensor is in the right ballpark ... and staying there each day. If it is out by a lot or if you get a "sensor failure" reported, in the UK, Abbott are pretty good at replacing sensor either via an online form or by calling. I do not know what that is like in Germany.
- Third party apps. Libre is "factory calibrated". Some of us find "factory man" does not represent them well. There are third party apps like Juggluco, Shuggah, xDrip+, Diabox, ... which allow calibration against a finger prick. These were very popular when Libre required scanning as they also converted the sensor into a rtCGM (real time CGM which did not require scanning). Some people still prefer them as they also allow things like integration with a smart watch. However, they may not update LibreView which could be an issue if you share that with your endo.


I think that is all and I have probably waffled for too long on something you may already know.
 
@helli That is definitely the most clear and comprehensive list of limitations I have ever read and I think it should be a sticky in the Pumps and Technology section.

@everydayupsanddowns Would the above be possible?
 
@helli Amazing! I didn't know any of that. Given how short the hypos were, sleeping on the sensor makes sense. And I did just change it yesterday.

TBH I have avoided finger pricking. I just look at the app and go, hmm, looks good, and then don't worry any more. Sounds like this is irresponsible of me.
 
Nothing to add to the great advice above @MarinaDE except to say that those secret fantasies are normal. They’re made worse by the honeymoon period which encourage such thoughts. For quite a while I thought about my diagnosis being a mistake, or a temporary blip, or some other condition that mimicked Type 1 and could be beaten. I think it’s normal to think such things 🙂
 
You can sometimes tell a compression low if it is a sudden dip and then returns to previous level on the graph, whereas during the night a real low would usually be a slow steady drift downwards. Sometimes your liver will release glucose to bring you back up if you get too low but once you get used to looking at graphs you can usually spot a compression low from a genuine one from the profile of it.

If you have not been told of the limitations of Libre and when you need to double check it with a finger prick then you can hardly be considered irresponsible. Unfortunately many DSNs and doctors are not even fully aware of these limitations themselves so difficult to tell you about them when they may not know. They are the sort of things that you become aware of when you live with this technology day by day and night by night and via this forum we can share experiences and compare notes and get a clearer understanding of the issues and what to do about them.
 
@MarinaDE I hope it’s okay for me to jump in here with my own honeymoon period question. I saw a comment somewhere online saying you can’t be in/have a honeymoon period unless you’re on insulin, because that’s what allows the pancreas to take a breather and produce more insulin (temporarily). I had thought it was just the meander to the body producing no insulin, regardless of injecting it? Can anyone clarify? So glad we have this forum where we can ask questions!
 
TwilightMidna said:
@MarinaDE I hope it’s okay for me to jump in here with my own honeymoon period question. I saw a comment somewhere online saying you can’t be in/have a honeymoon period unless you’re on insulin, because that’s what allows the pancreas to take a breather and produce more insulin (temporarily). I had thought it was just the meander to the body producing no insulin, regardless of injecting it? Can anyone clarify? So glad we have this forum where we can ask questions!
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It is an interesting question and I think, a bit like LADA, it has different interpretations.
To me it is the period of getting used to a new way of life with insulin, a bit like a honeymoon is getting used to a new way of life, living with another person. There are ups and downs with it. To me the diabetes honeymoon ends when your own insulin production peters out or becomes so negligible as to make no difference. I personally didn't see any reduction in insulin needs after I started injecting insulin but for me there were 3 clear phases (each lasting 2-3 months) where my insulin needs increased and then stabilized and since the last one 2.5 years ago my levels and doses have been pretty stable, give or take adjustment for seasons and exercise etc, so I am guessing that that is my beta cells done, but don't suppose I can ever be sure.
 
rebrascora said:
It is an interesting question and I think, a bit like LADA, it has different interpretations.
To me it is the period of getting used to a new way of life with insulin, a bit like a honeymoon is getting used to a new way of life, living with another person. There are ups and downs with it. To me the diabetes honeymoon ends when your own insulin production peters out or becomes so negligible as to make no difference. I personally didn't see any reduction in insulin needs after I started injecting insulin but for me there were 3 clear phases (each lasting 2-3 months) where my insulin needs increased and then stabilized and since the last one 2.5 years ago my levels and doses have been pretty stable, give or take adjustment for seasons and exercise etc, so I am guessing that that is my beta cells done, but don't suppose I can ever be sure.
Click to expand...
That makes sense, thank you!
 
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