📘 Partial remission (honeymoon period) in type 1 diabetes

The honeymoon period is a temporary phase after type 1 diabetes diagnosis when your pancreas still produces its own insulin. Once you start insulin treatment and blood glucose normalizes, the remaining beta cells (10-20%) recover from "glucose toxicity" and start functioning better again. Your insulin requirement from external sources drops dramatically, to only 0.1 units/kg/day and sometimes even to zero.

It is called a "honeymoon" because it seems like a magical period when diabetes appears to have disappeared. Blood glucose levels are stable, you don't have hypoglycemia and you feel almost normal. However, like any honeymoon, it is temporary. The autoimmune process continues to destroy the remaining beta cells, and after a period your insulin requirement will increase again.

The duration of the honeymoon period varies enormously, from a few weeks to almost 3 years, with an average of 6 months. In young children (under 5 years), it may be completely absent or last only 1-2 months, as the autoimmune process is generally more aggressive. Adolescents usually have 6 months, while adults diagnosed with LADA can have a honeymoon period of 3 years.

Factors that prolong the honeymoon period include excellent glycemic control from the start (prevents glucotoxicity), early diagnosis before ketoacidosis, older age at onset, and the presence of at most one autoantibody. You cannot predict the exact duration, but monitoring C-peptide and insulin requirement can show you when you are approaching the end.

You need less insulin during the honeymoon period because the surviving beta cells have partially resumed their function. When your blood glucose was very high before diagnosis, the beta cells were paralyzed by so-called glucose toxicity. Once blood glucose is normalized with external insulin, they recover and can produce insulin again, although often not enough for complete independence.

Additionally, your insulin sensitivity has improved. Your body's cells respond better to both injected insulin and internally produced insulin. It's like having temporary help that covers at least half of your insulin requirement, if not all of it. This residual production also makes control easier, with fewer blood glucose fluctuations.

Most often you cannot stop insulin completely. Sometimes, if blood glucose levels are perfect, you can do this, but with a lifestyle adapted for this situation. Stopping insulin during the honeymoon period when blood glucose levels and lifestyle do not actually allow it accelerates the destruction of remaining beta cells and can lead to ketoacidosis. Maintaining a minimum insulin dose (0.1 units/kg/day) prolongs the honeymoon period and residual beta cell function.

Even if your blood glucose seems normal without insulin, the autoimmune process continues. Without external insulin, beta cells are forced to work at maximum capacity, which attracts the immune system. External insulin gives them "rest" and may have a protective effect. Reducing doses according to needs is always a safe approach.

The end of the honeymoon period sets in gradually, not abruptly. Early signs include increased insulin requirement (0.5 units/kg/day), variable and harder to control blood glucose, reappearance of high morning blood glucose (dawn phenomenon), need for more frequent and larger corrections, and sometimes appearance of ketone bodies with persistent high blood glucose.

C-peptide monitoring objectively confirms the end of the remission period. When it falls below 0.4 ng/ml under conditions of blood glucose above 100 mg/dl (5.6 mmol/L), residual production is clearly insufficient. It is not a personal failure when the honeymoon period ends. It is the natural, inevitable evolution of the disease. Prepare yourself psychologically and practically for the transition, inevitable at some point, to more intensive diabetes management.

No, not everyone has a honeymoon period. At least half of patients experience a period of partial remission, but approximately one fifth go directly to complete insulin dependence. Very young children (under 5 years) and those with onset in severe ketoacidosis have fewer chances of a honeymoon period. Complete and rapid destruction of beta cells sometimes leaves nothing to recover.

Adults and those diagnosed early, before the appearance of severe symptoms, have higher chances of a honeymoon period. The presence of residual secretory function and excellent glycemic control from the start are positive predictors. The absence of a honeymoon period does not mean worse long-term prognosis, just the need for more intensive management from the beginning.

Yes, you can influence the duration of the honeymoon period through strict glycemic control. Maintaining blood glucose between 70-140 mg/dl (3.9-7.8 mmol/L) reduces stress on beta cells and slows destruction. Avoiding episodes of severe hyperglycemia and ketoacidosis is crucial. These accelerate the loss of residual secretory function. HbA1c below 7% (53 mmol/mol) in the first year is associated with a longer honeymoon period.

Regular physical exercise improves insulin sensitivity and reduces requirements, indirectly protecting beta cells. Some studies suggest that a moderate low-carb diet may help. Participation in clinical trials with beta cell function maintenance therapies (immunomodulators) offers additional chances of prolonging the temporary remission period.

Blood glucose fluctuates during the honeymoon period due to unpredictable endogenous insulin production. The remaining beta cells do not function consistently. Sometimes they produce more, other times less, depending on several factors, such as stress, sleep or various infections. This variability overlaps with the insulin you possibly inject, creating unpredictability.

Additionally, beta cell response to stimuli (food) is delayed and inadequate. The remaining beta cells can sometimes release insulin when they shouldn't, leading to unexplained hypoglycemia. Other times they seem not to respond when needed, with the appearance of hyperglycemia after a somewhat larger meal. It is frustrating, but temporary. Flexibility in dosing and frequent monitoring are the keys to adapting to these fluctuations.

It is absolutely normal and beneficial! Partial remission means you still have residual beta function, which makes management easier, though temporarily. Partial refers to the fact that you don't stop insulin completely. It is not a cure or a sign that the diagnosis was wrong. It is part of the natural evolution of type 1 diabetes in most patients and should be valued for as long as it lasts.

The presence of a honeymoon period is associated with better long-term prognosis. The reason lies in better glycemic control, with lower variability and lower risk of chronic complications. People who maintain detectable C-peptide even many years after diagnosis (minimal beta function) have lower glycemic variability and lower risk of severe hypoglycemia. Enjoy this period, but prepare realistically for what comes next.

After the honeymoon period, you will need full insulin doses (0.7-1.0 units/kg/day or more in adolescence). Glycemic control becomes more difficult, with increased variability and the need for frequent adjustments. Dawn and dusk phenomena become evident, requiring differentiated basal rates if you use an insulin pump. Insulin sensitivity fluctuates more with menstrual cycle, stress or various infections.

Nothing serious, just a new stage that requires adaptation. Modern technologies (pumps, sensors, closed-loop systems) make management much easier than in the past. Most people adapt within a few months to the new normal.