I am a 29 year old man with Type 1 (onset about 6 months ago). I am very thin about 5'11" and 135 pounds. I know insulin requirements are tied to weight and I take about 7 basal units and about 10 bolus units a day. My doctor says that will be the least I ever take, How do you know when the honeymoon period is ending. My sugars are about 80-90 in the morning and generally range from 75-130 intraday. He says that in a few years I'll be taking much more insulin and will be happy if I am 160 2 hours after a meal. Is that really true, will my numbers become way more out of whack?
On a side note, I was 220 fasting before diagnosis and 8.5% A1C before diagnosis. Now I am at 6.2
My observation is, that T1’s diagnosed as adults seem to have a much longer honeymoon period, which can last years and years. And some of the medical literature I read indicates that some T1’s diagnosed as adults continue to have their pancreas supplying at least some insulin for decades.
I don’t think you should try to measure your quality of life based on your insulin dose or postprandial bg’s.
I’ve been T1 for 30 years and I would love to have bg numbers as stable as yours. Don’t take that as meaning that my bg’s are high all the time, but the natural stability by having a pancreas doing at least some of the work is something I may have had in the first few years after diagnosis, but I definitely do not have anymore!
Oh, at diagnosis I was in deep DKA with a bg above 1500 when they eventually checked it. I didn’t have my first A1C run until maybe 4 or 5 years after that.
I got diagnosed with type 1 very recently (6/7/10) and I asked my NP the same question – she said that once my body stops producing endogenous insulin, my insulin needs will not necessarily increase dramatically. But if you search the internet, you will find that how long the honeymoon phase lasts depends on the individual, and apparently a low carb diet helps.
But I defer to others here to offer a better explanation as I am a total newbie to this condition.
You’ll know when your honeymoon is ending when your readings increase eating the same number of carbs using the same I:C ratio. The closer to normal you can keep BG, the longer your honeymoon will last.
I’m taking less insulin & have better numbers now then I was two years ago. So there–to your doctor:) As soon as I threw the ADA guidelines out the window & began eating low carb, everything improved & leveled out.
Your numbers won’t go out of whack if you’re diligent about testing, eating sensibly, exercising & making insulin adjustments.
Your doctor (like so many) is a bit of an idiot! Nobody should ever be happy with a blood sugar of 160! That doesn’t mean they don’t sometimes happen, but that we try and avoid them however we can! You will know your honeymoon is ending when your blood sugars start to rise and you have to increase your I:C ratios. Congratulations on your decreased A1C. Sounds like you’re doing great. I don’t know that insulin doses are tied to weight so much as tied to insulin resistance (or lack thereof) and how much insulin we are still making ourselves, as well as how many carbs we eat. And maybe to the phases of the moon! If your I:C ratios are working to keep you in range then your dose is correct for you! I don’t know about taking “much more insulin”. I’m probably not making anymore of my own and I take basal of 13 and bolus around 10 as well. We’re all different.
All other things being equal, as your beta cells crap out, your insulin dosage increases. However, insulin dosage depends on a lot of things. Same with your BG profile. Definitive statements about your future insulin requirements and post meal BG at this point don’t mean much.
I do remember reading a clinical paper stating ).55 u per KG of body weight, however in this paper it was in regards to MDI - this would be much much lower on a pump
From the other responses, I guess that it is not everyone’s experience, but I experienced exactly what your doctor described. I was diagnosed at the age of 21 in diabetic ketoacidosis in the ER with an A1c of 12.1 – so my diabetes was caught a lot later than yours. This might mean that your honeymoon will last much longer, but I don’t think that there is a good way to know how long.
I used to take 7 units basal (Lantus) and 1 unit of insulin for every 30 grams of carb right after I was diagnosed (while I was in my honeymoon). I almost never saw numbers above 150. Then one day, I woke up at 400 mg/dl and it was clear that something had changed. My insulin needs doubled (14 u basal and 1 unit of insulin for every 15g of carb).
Your numbers will not necessarily become way more out of whack, but you may need more insulin. I do see numbers above 150 now and I have to be much more diligent to avoid highs than I needed to be during the honeymoon. Preserving some insulin function for as long as possible is great – there are some indications that good blood sugar control now and eating less carbs can help you do that. But at the end of the day, there is an autoimmune attack occuring on your pancreas and you are likely to see decreased insulin production over time. If you find yourself needing more insulin, this should not be preceived as a failure.
These days I am maintaining my blood sugar pretty well and I aim not to go above 160 mg/dl one hour after eating and I aim to not be above 140 mg/dl two hours after eating. I can do this without following a low carb diet (I eat 45 g at breakfast, 60 g at lunch, 45-60g at dinner). I have found that the only way to totally avoid going above 140 is to eat very low carb, which I choose not to do (but I agree strongly with those who support this).
Wow thanks for the insight. I eat about 35-35-50 for breakfast lunch and dinner and maybe twice a week see numbers above 160, if that. I wish I knew how long the honeymoon period was. I asked my doctor if we can test to see if I am still producing insulin and he was like you don’t need a test for that, you’ll just see higher numbers.
With tight control, you can keep your honeymoon going for many many years. There is a Stanford endo that is doing clinical trials to extend the honeymoon, and he immediately (at diagnosis) puts patients on a pump and a CGM and teaches tight control methods. He has had tremendous success with this method. It really is beneficial to your health to extend the honeymoon as long as possible.
A c-peptide test will indicate how much of your own insulin you are still making.
Thanks - I am actually on both now, the pump and CGM. My Dr. for some reason said just adjust your insulin to your numbers instead of seeing if I am still producing insulin
Seriously! Some doctors just don’t think before they speak. It’s that kind of attitude that ‘programs’ diabetics to think that they just can’t hope to do better than an A1c of 7 or a post-meal bg of 160. It’s a huge disservice.
That is the norm. C-peptides are rarely done on T1s. The results are certainly of personal interest, but it is an expensive test that will have no bearing on treatment (ie you’ll be adjusting your insulin dose as your #s increase regardless of what your c-peptide is).
On the subject of honeymoons; I am a T1.5 female dx about 8 months ago… and I find the honeymoon period very annoying. Sometimes my pancreas decides to produce insulin at random times and causes me to have lows for no real reason… either that or this is just normal for a T1 (?) I am on the Animus insulin pump and take about 0.125 - 0.175/hr for a basal rate, which alternates with hormones, and my I:C ratio is 1:20. I also have a Dexcom CGMS, which is a god send (although the alarms do get annoying at times… but definetly worth it!)
Type 1.5 is a term used for “Latent Autoimmune Diabetes in Adults” (LADA) – This is a slow onset form of type 1. You can read more info here. Just a word of warning, many endocrinologists do not recognize type 1.5 – so don’t be surprised if your doctor tells you that there is no such thing – or just that the distinction between type 1.5 and type 1 is not important. Given that you were diagnosed as type 1, it might not be important to clarify, but for many people who are misdiagnosed as type 2, it matters a great deal, as they may require different treatments.
