What Is the Honeymoon Phase in Type 1 Diabetes?

The honeymoon phase varies widely from one patient to another. Many will never experience a honeymoon period, while some lucky patients may even be able to pause their insulin injections entirely, at least for a while.

“For some, the honeymoon phase occurs when you start insulin therapy — the stress this relieves on your pancreas can be significant,” says Chris Szoke, CDCES, a nurse practitioner and diabetes specialist based in Tuscon. “The result is that your pancreas starts to produce more of its own insulin, but this is absolutely temporary.”

“The [autoimmune] attack on your pancreas is gradual,” says Szoke, who has type 1 diabetes himself. “While it might feel like you’re producing zero insulin at the time of your diagnosis, [even] when your blood sugar is 600 milligrams per deciliter (mg/dL), you are still producing some.”

As many as two-thirds of patients newly diagnosed with type 1 diabetes may experience the honeymoon phase.

It’s impossible to say who will or won’t experience a honeymoon phase, but researchers have identified some factors that make it more or less likely to occur.

“It is very common for people diagnosed during adulthood to experience a more significant honeymoon phase because the attack on the pancreas tends to be much slower,” adds Szoke.

There is no one-size-fits-all approach to insulin management during the honeymoon phase.

“Like any phase of type 1, you’ll have to work closely with your healthcare team to gradually start or increase insulin doses based on your glucose data,” says Szoke.

Some people during the honeymoon phase, more likely adults, may be able to delay the need for daily insulin therapy for some time. Some people may only need a smaller amount of long-acting basal insulin to keep blood glucose levels in range. Others may need intensive insulin therapy — a combination of long-acting basal insulin and short-acting rapid insulin between meals.

“Some people produce enough insulin during the honeymoon phase to keep their blood sugar levels in range without any additional insulin, but most people will likely need some bolus or basal insulin,” says Szoke.

Regardless of the strength or duration of the honeymoon period, it always comes to an end.

“It is inevitable: You will need more insulin,” says Szoke. “I’ve seen many newly diagnosed adults go on ketogenic diets, believing they’ve cured their type 1 [diabetes] and eliminated the need for daily insulin,” says Szoke. “In reality, all they’ve done is combine the honeymoon phase with a severely restricted diet that calls for very little insulin. In time, their blood sugar levels will rise as that honeymoon phase dwindles.”

Work closely with your healthcare team to monitor your blood glucose levels and adjust your insulin regimen based on your body’s gradual loss of insulin production.

The honeymoon phase may confer health benefits:

• Children with residual beta cell function three years after diagnosis experience a “lower risk for severe hypoglycemia, have better diabetes regulation, and have lower insulin requirements.”

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• Children who experienced a honeymoon phase have significantly improved LDL cholesterol, even five years after diagnosis.

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The honeymoon phase may bring improvements to both short- and long-term health, not to mention a better quality of life. Generally speaking, the less insulin you require to achieve healthy blood sugars, the less stressful your diabetes management will be.

“The honeymoon phase is a double-edged sword,” says Szoke, “because it’s obviously beneficial to achieve in-range blood sugar levels with little effort, but it can be very difficult for patients when this phase ends.”

It’s impossible to say. The honeymoon phase lasts different amounts of time for different people.

Older patients and those with less severe symptoms are more likely to experience longer honeymoon phases. But to put it simply, there’s no telling how long your honeymoon phase will last. And if you’re newly diagnosed, there’s no telling whether or not you’ll experience one at all.

Some studies have suggested that it may be possible to extend the honeymoon phase in type 1 diabetes through these means:

• Exercise Newly diagnosed patients who exercise frequently have far longer honeymoons (28.1 months) than those who are mostly sedentary (7.5 months).

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• Vitamin D Supplementing with vitamin D may prolong the honeymoon and improve blood sugar control.

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• Tight Glucose Control Optimal blood sugar control may prolong the honeymoon phase by reducing the negative effects that glucose toxicity may have on any surviving beta cells.

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• GLP-1 Medications Semaglutide, an injectable medication for type 2 diabetes and obesity, may reduce the need for insulin in newly diagnosed type 1 diabetes patients.

While none of these proposed remedies above can be considered scientifically validated, they may be worth discussing with your medical care team.

The honeymoon phase is the focus of intense study in the research community, and many laboratories are investigating potential therapies intended to help extend the period. Although these treatments aren’t ready for regular patients yet, it may be worth asking your healthcare providers if you qualify for any nearby clinical trials.

All honeymoons come to an end eventually. It may be impossible to pinpoint when exactly the phase has ended, but eventually, you will find yourself needing more and more insulin to keep your blood sugar levels in the same healthy range.

“The hardest part for many people is when this phase gradually ends and your insulin needs start rising, sometimes very quickly,” says Szoke.

The end of the honeymoon doesn’t necessarily mean that your beta cell function has already declined to zero. Contrary to popular understanding, not everyone with type 1 diabetes experiences a complete loss of beta cell function, even after many years.

• The honeymoon phase is a temporary period of partial remission experienced by a majority of people with type 1 diabetes soon after they have been diagnosed with the condition.
• During the honeymoon phase, which typically lasts for several months, you may require less insulin to keep your blood sugar levels in range. Some people may not require any insulin at all.
• The honeymoon phase is unpredictable — it’s critical to work closely with your healthcare team to monitor blood glucose levels closely and discuss changes to your insulin usage.