Does active preservation of the honeymoon period improve lifetime prognosis?

[MarkMunday]

How long it takes for insulin production to shut down completely depends mostly on two things. Age at diagnosis and the level of blood glucose control. Diagnosis in adulthood usually means a longer honeymoon, and it can continue for many years. On the other hand, blood glucose toxicity kills remaining beta cells, shortening the honeymoon. Trace c-peptide is found in people who have had T1 for 30+ years, showing they still produce some insulin. These people are usually well controlled and have fewer complications.

My neighbour, who now uses my old pump, still makes much of his own insulin after 17 years of T1. His HBA1c is always in the 30's, so he doesn't qualify for a funded pump. But he really needs one because he is very active and he needs to suspend insulin action during exercise. It is a bit of a catch 22 situation.

I wouldn't move onto a pump as long as MDI gives satisfactory control. Having switched back to MDI, my control is now better than ever. I also like being able to remount my surfski without worrying about the pump. So I probably won't use a pump again. Don't wish away your honeymoon. It is a closing window of opportunity and using it wisely improves lifetime prognosis.

 

[DCUKMod]

How long it takes for insulin production to shut down completely depends mostly on two things. Age at diagnosis and the level of blood glucose control. Diagnosis in adulthood usually means a longer honeymoon, and it can continue for many years. On the other hand, blood glucose toxicity kills remaining beta cells, shortening the honeymoon. Trace c-peptide is found in people who have had T1 for 30+ years, showing they still produce some insulin. These people are usually well controlled and have fewer complications.

My neighbour, who now uses my old pump, still makes much of his own insulin after 17 years of T1. His HBA1c is always in the 30's, so he doesn't qualify for a funded pump. But he really needs one because he is very active and he needs to suspend insulin action during exercise. It is a bit of a catch 22 situation.

I wouldn't move onto a pump as long as MDI gives satisfactory control. Having switched back to MDI, my control is now better than ever. I also like being able to remount my surfski without worrying about the pump. So I probably won't use a pump again. Don't wish away your honeymoon. It is a closing window of opportunity and using it wisely improves lifetime prognosis.

Mark, could you reference your statement that ".... It is a closing window of opportunity and using it wisely improves lifetime prognosis.", please?

I'd like to read that, as I have read a number of viewpoints on the advantages/disadvantages of being on honeymoon.

Thanks.

 

[MarkMunday]

Mark, could you reference your statement that ".... It is a closing window of opportunity and using it wisely improves lifetime prognosis.", please? ...

There is not much data around on this, mainly because people who have lived with T1 for 50+ years have had to use relatively poor methods of control for much of their T1 duration. So making comparisons is difficult. Perhaps the best source of info on this is the ongoing Joslin Diabetes Medalist study.

Beta cell preservation and insulin production is only part of the puzzle, but the Joslin study found that many 50 year medalists were still making c-peptide. That they were still making insulin helps explain the lack of complications. So preserving beta cells is definitely worth it in the long term.

Allowing beta cells to be destroyed so the honeymoon ends is not a good long term strategy. Richard Bernstein maintains that functional beta cells can be preserved indefinitely by minimising carb consumption and using small amounts of insulin only where it is needed. This really needs to start at the time of diagnosis, though. It is a closing window of opportunity.

 

[DCUKMod]

There is not much data around on this, mainly because people who have lived with T1 for 50+ years have had to use relatively poor methods of control for much of their T1 duration. So making comparisons is difficult. Perhaps the best source of info on this is the ongoing Joslin Diabetes Medalist study.

Beta cell preservation and insulin production is only part of the puzzle, but the Joslin study found that many 50 year medalists were still making c-peptide. That they were still making insulin helps explain the lack of complications. So preserving beta cells is definitely worth it in the long term.

Allowing beta cells to be destroyed so the honeymoon ends is not a good long term strategy. Richard Bernstein maintains that functional beta cells can be preserved indefinitely by minimising carb consumption and using small amounts of insulin only where it is needed. This really needs to start at the time of diagnosis, though. It is a closing window of opportunity.

Thank you. is that the correct link you posted there? It seems be relate to hypoglycaemia and brain death, as opposed to post diagnostic honeymoon periods and longevity?

 

[MarkMunday]

... is that the correct link you posted there? It seems be relate to hypoglycaemia and brain death, as opposed to post diagnostic honeymoon periods and longevity?

Oops .. that is another article I was reading. Here is the correct link to the Joslin Medalist study. Click on Results for a summary of findings.

 

[DCUKMod]

With respect @MarkMunday, whilst I wholeheartedly tug my forelock to those living with T1 diabetes for many decades, I see nothing in that article (https://www.joslin.org/research/our-research/medalist-program-study#), which is essentially a one-pager, discussing honeymoon period, it's preservation or increased longevity.

Whilst I see some interesting findings, I see nothing in the summary, you signposted, stating that preserving the honeymoon period improves prognosed longevity. If I have missed that statement, backing up your own, please do point it out to me.

Unless you can point me to something, referencing peer reviewed research, from a respected source, more aligned to your own statement, then I find it unacceptable to make definitive statements based on such scant suggestions.

 

[MarkMunday]

... Whilst I see some interesting findings, I see nothing in the summary, you signposted, stating that preserving the honeymoon period improves prognosed longevity. If I have missed that statement, backing up your own, please do point it out to me.,.

This is an epidemiological study, so it doesn't jump to conclusions. But the logical connections are clear. The study found that many of the 50+ year complication free medalists still had active beta cells. They produce both c-peptide and insulin. It goes almost without saying that destruction of beta cells to shorten the honeymoon and precludes this outcome - having active beta cells after 50+ years of T1 duration. That having these beta cells improves control and the long term complication outcome is more tenuous, but it would not be surprising. Conversely, preserving beta cells, which also keeps the 'honeymoon' going as long as possible, improves the long-term prognosis.

If we accept that poor control causes complications and residual beta cell function makes control easier, the long-term case of preserving beta cells is compelling. The researchers did not jump to this conclusion as they are still looking for other possible protective factors, like genetics. There are no-doubt other factors that affect long-term T1 outcomes. But as diabetics, we can only work with things we can control. Like diet, exercise and insulin regimen. Preservation of beta cells is something recently diagnosed T1s can do, and the indications are that it will make life easier for them down the road. This is why I urge newly diagnosed T1s to make the most of this opportunity. Yes, I could be wrong and it turns out preserving beta cells doesn't help. But is that a risk worth taking?

And, BTW, everything everyone writes on an online forum is opinion. If asked for an explanation, I give it. Much of what your doctor tells you is also just opinion. Ultimately, you need to do your own research and reach your own conclusions. I really don't mind if people don't agree with me, as long as their arguments are sound. Saying that you don't agree with something because it doesn't come from a peer reviewed published article doesn't tell me much about your interpretation and objection.