How do you know when you are out the Honeymoon Phase?

[AlisonBaxter]

I was diagnosed in Jan 2023, and was wondering what signs to look out for when coming out of my honeymoon phase? I am on such little doses of insulin currently, 5 units levermir and either 1 or 2 units or Novorapid for meal times.

Thanks in advance

 

[CavJ]

Hi AlisonBaxter
I’m commenting on this to try follow the post as I’m the same-diagnosed T1 early Jan. I started semglee 2 weeks ago (6 units) and my sugars have now gone way too high so from tomorrow that will be going up to 10 units and I’m starting novorapid (2 units) before dinner tonight. So worried I’ll have a hypo!
But I think this is my honeymoon phase coming to an end or it’s a blip from having covid 2 weeks ago (only tested negative last Friday).

 

[Ipodlistener]

Everyone is different. I got diagnosed 11/21. I'd say I'm still in honeymoon phase. But my usage is going up slowly. I'm an active person. What I must say was getting my basal right was the biggest step. Also learning if you want to stay in range. Some foods you can't eat in one go. Unlike before.

 

[Zhnyaka]

as far as I know, during the honeymoon, the dose of basal is less than 0.5 units per kilogram of weight. Although I inject 0.3 units of basal per kilogram of weight, but this is clearly not a honeymoon (perhaps this is because the effect of the tresiba lasts about 48 hours). And when your honeymoon is over, the c-peptide level will be below 0.5 nmol/l.

The honeymoon can last from several months to several years. In theory, in adult patients it lasts longer, and in children it is finished very quickly, but everything is individual.

The sad truth is that the correction of the insulin dose may be required even after the honeymoon

 

[NathonalCoalBoard71]

I think you will know when your basal rate needs to go up i.e. you are awakening with high bgs because your beta cells can't produce enough insulin to control the glucose which your liver produces to get you through the night.
The True Grit people (Facebook) /Dr Bernstein (The Diabetes Solution) suggest eating very low carb to help preserve beta cell function as long as possible and this is also a way to get smoother blood sugars therefore reducing hypos/hypers.
I wouldn't normally suggest something so radical to those who are getting used to a diagnosis like this but this possible solution is obviously time critical.

 

[NathonalCoalBoard71]

as far as I know, during the honeymoon, the dose of basal is less than 0.5 units per kilogram of weight. Although I inject 0.3 units of basal per kilogram of weight, but this is clearly not a honeymoon (perhaps this is because the effect of the tresiba lasts about 48 hours). And when your honeymoon is over, the c-peptide level will be below 0.5 nmol/l.

The honeymoon can last from several months to several years. In theory, in adult patients it lasts longer, and in children it is finished very quickly, but everything is individual.

The sad truth is that the correction of the insulin dose may be required even after the honeymoon

I have had type 1 for 40 years and so well out of the honeymoon periiod. My basal is much less than your bodyweight formula suggests even considering I'm on a pump meaning dose delivery is more efficient. Still other than when pregnant I've never had such insulin resistance that I've gone much over 0.25 per kg. Just interested to know where your ratio comes from!
As you infer at the end of your response, insulin dosing is seemingly more of an art than a science with many more variables than bodyweight.

 

[Jaylee]

as far as I know, during the honeymoon, the dose of basal is less than 0.5 units per kilogram of weight. Although I inject 0.3 units of basal per kilogram of weight, but this is clearly not a honeymoon (perhaps this is because the effect of the tresiba lasts about 48 hours). And when your honeymoon is over, the c-peptide level will be below 0.5 nmol/l.

The honeymoon can last from several months to several years. In theory, in adult patients it lasts longer, and in children it is finished very quickly, but everything is individual.

The sad truth is that the correction of the insulin dose may be required even after the honeymoon

Oddly, doing the maths. That’s probably the formula they must have used to advise on my basal dose when first starting MDI? (Over 34? Years back?) it’s less than quarter that dose now. (I’ve long since titrated the dose down on my own initiative. I was “captain hypo when I first stated the regime. & I had some doozies in the 12 years preceding..)

 

[Antje77]

I was diagnosed in Jan 2023, and was wondering what signs to look out for when coming out of my honeymoon phase? I am on such little doses of insulin currently, 5 units levermir and either 1 or 2 units or Novorapid for meal times.

Thanks in advance

I have no idea when (or even if) I'm out of my honeymoon phase, and it wouldn't change anything if I knew.

I've had my C-peptide tested once, 4 years ago, 2 years after diagnosis.
At that point my result was just below low normal, so I still produced some insulin.

My insulin needs have gone up over the years (I'm on quite high doses, thanks to some insulin resistance) but they've more or less stabilised over the past year, so maybe that means my honeymoon is over. Or maybe it doesn't.
Doesn't make a difference really, I adjust my doses depending on my blood glucose, no matter if I still produce some insulin or not.

 

[AlisonBaxter]

Thanks for all the responded, it’s really helpful.
I guess I asked this question as my BG levels have been high the last week and I cannot get them down at all (not high enough to test for Ketones), I have been slowly increasing my basal and bolus however it’s still high.
I might also add, I am taking co amoxiclav due to an a infected animal bite, aswell as that I am also getting over the flu.
I would really benefit in a follow up appointment with my diabetic nurse to go though my units again, or atleast to attempt to work out a ratio as this has not been done yet as I am too insulin sensitive.
I have my first diabetic dietician appointment in 2 weeks, perhaps this is something they can go through with me.

 

[Mrs HJG]

Hi @AlisonBaxter it's likely to be so individual from what I have gleaned, and trust me, I have read so much to get an answer, as I am currently honeymooning without insulin, and live in fear of the day that all changes.

I was told that if/when I start waking constantly over 6, and staying above 8 for extended periods after eating, it will be time to start insulin, and the honeymoon will be ending.

I eat low carb, (100g/day, c.25g per meal plus a couple of nut snacks), and exercise daily - so although my diet is restricted it is not identical each day, but my Libre helps keep me in check and see where I have gone over night and the real spikes etc.

If I ate a 'normal' carb-filled diet I am sure I would need to be on insulin to get my levels down, and be stressing my pancreas into quick submission. As I'm not a 'foodie' I am happy to 'go without' and prolong my time without insulin in any way I can, including reducing as much stress as possible, (spikes me more than a bag of jelly babies, probably!), and following @glucosegoddess on instagram's hacks (Jessie Inchauspé).

From my own experience I would say the honeymoon will be over when insulin is needed and small amounts don't bring on a hypo because my pancreas has stopped being 'helpful' - I tried for 3 weeks and on 3 units of humulin M3 twice a day I was dipping to the low 4s and treating with Quality Street (it was Christmas!) from being in the 20s at diagnosis aged 51, so I needed to come off it for my sanity.

After 12 months of low carb my HbA1c has kept reducing and my GAD antibodies have also decreased, and I will have my c-peptide re-checked in the summer, as I am bit of an anomaly.

I totally get the wanting to know and have 'proper' definitive answers, but after 16 months I am (happily?) resigned to the fact that with diabetes, there is no such thing.

Just seen you latest post - infections, illness, antibiotics, steroids (everything!) will increase most likely your BG, hopefully temporarily, so I would expect your insulin requirement to go back down a bit when you recover, but your diabetes team will be able to guide you on that.

 

[Antje77]

infected animal bite, aswell as that I am also getting over the flu.

Both infection and flu is notorious to raise numbers.

Many of us use 'sick day rules' an adjustment of insulin when we're ill or are fighting an infection.
It's completely normal to see higher numbers and/or need more insulin in this situation, no matter if you still produce insulin or not.

 

[Antje77]

I was told that if/when I start waking constantly over 6, and staying above 8 for extended periods after eating, it will be time to start insulin, and the honeymoon will be ending.

Starting insulin is not the same as the honeymoon ending.
You can produce insulin for years while you're already needing insulin as well.

 

[Deleted member 527103]

I was started on insulin when first diagnosed.
I found my insulin needs slowly rose. I put this down to more insulin producing cells dying off. It was not due to weight gain or change in diet or lifestyle.
Every few months, I increased my insulin dose. It wasn’t a consistent number of months. Just a feeling that my current dose was not enough for more than a week.
After about 8 years, my insulin needs stayed about the same (accounting for exercise, alcohol, stress, illness, …).
I may be wrong but I interpreted this as my honeymoon period lasting about 8 years.

I am surprised to read that @Mrs HJG is currently not taking insulin, My understanding was that injecting insulin protects insulin producing cells for longer as they are not stressed.
It is also very important to treat hypos with fast acting carbs. Chocolate is not a fast acting carb as the fat slows down the speed. However, low 4s are not hypos.

 

[Mrs HJG]

I am surprised to read that @Mrs HJG is currently not taking insulin, My understanding was that injecting insulin protects insulin producing cells for longer as they are not stressed.
It is also very important to treat hypos with fast acting carbs. Chocolate is not a fast acting carb as the fat slows down the speed. However, low 4s are not hypos.

I stopped the hypos occurring, after the first, by eating whatever I had to hand at that point, toffees etc, as I was getting no help from my local diabetes nurse, and because even tiddly amounts of injected insulin and 'moderate' endogenous insulin just took me too low, too quickly - as my stats show now, extra insulin definitely not needed (yet). It was the most scary, and looking back most ridiculous time as the nurse was only used to prescribing T2s to eat brown rice and lose weight, and with my 14% HbA1c but only 0.7 ketones she was as clueless as me.

Injecting insulin would mean, because of my own current production, that things like just popping out in the car at any given point etc, would not be possible, which with 3 kids is often needed, and I take a tonne of other protective supplements inc. Metformin, vit D/K, zinc, selenium etc and have the HbA1c to prove it's working. Why would I take on board extra insulin and have to constantly eat 'carbs/sugars' to counteract it and get on that rollercoaster!?

Endo says as it's not normal presentation, we just have to wing it and see, but to keep doing what I'm doing, as its definitely working! I am good with that for as long as it lasts.

 

[Mrs HJG]

Starting insulin is not the same as the honeymoon ending.
You can produce insulin for years while you're already needing insulin as well.

For me, I will view my honeymoon ending when insulin is needed and I am not producing enough to interfere, and over when, if I don't take on insulin, my numbers would be in 'diabetic' range again. How others draw the line may well be very different. For me honeymooning is when you still produce enough of your own, and can manage with diet and exercise (similar to T2).

 

[EllieM]

For me, I will view my honeymoon ending when insulin is needed and I am not producing enough to interfere, and over when, if I don't take on insulin, my numbers would be in 'diabetic' range again. How others draw the line may well be very different. For me honeymooning is when you still produce enough of your own, and can manage with diet and exercise (similar to T2).

As @AlisonBaxter is taking insulin (albeit very little) I think your definition (while fine for you) is probably not very relevant to her. You seem pretty unusual that your cpeptide wasn't low on diagnosis? I have no memory of a honeymoon phase (diagnosed as a child pre-glucometer) but my understanding from the posts I've read here is that it's when your insulin production reduces significantly and you become mostly dependent on the external stuff? There is an interesting article here

The type 1 diabetes honeymoon phase

Why does the pancreas jet off on honeymoon? Type 1 diabetes happens when the immune system attacks insulin-producing beta cells in the pancreas. At the point when you’re diagnosed, not all of your beta cells have been wiped out yet. The cells that haven’t been destroyed are reeling from the...

www.diabetes.org.uk

But @AlisonBaxter if you've just had the flu and are on antibiotics it's likely that your insulin needs would be higher anyway (mine certainly would) so I think you'll probably have to wait and see if that increase is permanent. It's good that you are seeing your team soon. (I suggest writing down a list of questions to ask them),

 

[Mrs HJG]

As @AlisonBaxter is taking insulin (albeit very little) I think your definition (while fine for you) is probably not very relevant to her.

Precisely my point, it is different for everyone and I was saying what I would consider being the end of 'my' honeymoon won't be the same for every/any one else. As we don't necessarily present the same, at the same age, with the exact same pancreatic function, eating the same diet and the same other health issues etc etc, frustratingly there is no one answer.

When you are new to all this, especially with many 'non-diabetic' years under your belt, I totally get wanting definitive answers and it took me a year to accept diabetes doesn't work like that, and worrying from BG finger prick to the next that it was all 'getting worse'; getting Libre after 6 months, and then understanding the quirks, limitations and irregularities of the tech over the following months has been a godsend/eye-opener/stress-reliever.

It takes time to 'know' what will make you go up, (illness, medicine, wonky Libre, dodgy test strip) or down, (wonky Libre, virtuous meals and exercise etc), so that one or 2 rogue readings don't scare the bejesus out of you.

Those of us in the LADA camp have a very different experience to those whose parents take on the 'thinking' for their offspring at diagnosis, and with the changes in tech, again it's very different I'm sure for those diagnosed with any diabetes inc. LADA 20, or maybe even 5 years ago to those since covid, and in the UK since the NICE extension of the CGM prescription rules last year.

 

[Deleted member 527103]

@Mrs HJG as long you understand what your honeymoon phase definition means for you, that is fine.
However, once you start insulin, it is unlikely that your insulin levels will remain and they are likely to rise over time which could be months or years.
The definition of the end of the honeymoon phase I have used is when this increase in insulin needs stabilises. There will still be times after than when you may need more (e.g. illness or stress or less exercise than usual).

 

[Mrs HJG]

@In Response I am currently 'on the beach', but as soon as I have to get on the bus to the airport, (which might whiz me there quickly, or take an agonisingly long route via all the other hotels), well that's the honeymoon coming to an end as far as I'm concerned; I totally get that for others it might not be over until they are back home, unpacked, done the washing and ordered a takeaway - we all draw the line at different stages. I am not going to continue the analogy that married life is the same as life on insulin, but...

So back to the OP, there is no single answer that will be agreed or experienced by all.