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The type 1 diabetes honeymoon phase

In the period after a diagnosis of type 1 diabetes, some people experience a ‘honeymoon’ phase. During the honeymoon the pancreas is still able to produce a significant amount of its own insulin. This helps to lower blood sugar levels and can reduce the amount of insulin you need to inject or pump.

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 attack and so aren’t doing a very good job of releasing insulin.

But once you start insulin therapy and bring your blood sugar levels down, surviving beta cells get a breather. They’re no longer struggling to do all of the work themselves and can sometimes make a partial recovery. Plus, high levels of sugar in the blood can be harmful to cells, and once levels are lowered, beta cells are able to work better.

Some scientists and doctors call this honeymoon a period of ‘partial remission’. But it’s important to remember that type 1 diabetes hasn’t gone away or been reversed. And the recovering beta cells likely won’t be able to pick up the slack indefinitely.

What makes the honeymoon more likely?

This partial recovery doesn’t appear to happen in everyone with type 1 diabetes and a team of scientists at Imperial College London investigated why.

They used ADDRESS-2 – a collection of information and blood samples from over 5,000 people newly diagnosed with type 1 diabetes, funded by Diabetes UK, to look at the characteristics of those who did and didn’t experience a honeymoon.

They followed participants for 12 months after their diagnosis and defined a honeymoon period as a daily insulin dose of 0.4 units per kg of body weight (which is less insulin than most people with type 1 would typically take), with an HbA1c of less than 53 mmol/mol (7.0%).

They found that the honeymoon was most likely to occur three months after a type 1 diagnosis, but can begin anywhere up to 12 months after.

The team also found that the age of diagnosis was a key predictor of whether someone experienced a honeymoon phase. In those diagnosed when they were 20 years old or older, a third (34%) had a period of partial recovery at some time in their first year of having Type 1 diabetes. In children and younger adults (diagnosed before 20 years) this dropped to 15%.

It’s likely that this is because older people have been found to have a less aggressive immune attack, and so more beta cells are still intact at the time of their diagnosis. 

In the younger group only, there were a few other factors that made having a honeymoon more likely:

  • being male
  • having fewer symptoms of type 1
  • not developing DKA
  • having a lower early HbA1c (less than 7%).

The researchers believe that being diagnosed without symptoms or DKA, and having a lower HbA1c could also be signs of less severe beta cell destruction. This stresses the importance of diagnosing type 1 diabetes early, to help children and young people keep hold of their surviving beta cells for longer.

The research team did look at a range of other factors they thought might predict the likelihood of having a honeymoon phase, but found no links with being overweight, ethnicity, a history of autoimmune conditions, a family history of type 1 diabetes or autoantibody status (signs that the immune system is attacking beta cells).

An extended honeymoon

There's more we need to learn about why some people have a honeymoon phase, other don't and what predicts how long people stay in the honeymoon phase for. 

But our scientists are also researching new treatments, called immunotherapies, which could help people newly diagnosed with type 1 diabetes to keep their beta cells working for as long as possible, and effectively extend their honeymoon period.

Immunotherapies work to reprogramme the immune system to stop or slow its destruction of beta cells in the pancreas. They're being tested in clinical trials with people who've just been diagnosed with type 1 diabetes with the aim of preserving remaining beta cells. Discover more about how immunotherapies work and how they could help people with or at risk of type 1 diabetes in the future. 

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