Understanding the Honeymoon Phase in Type 1 Diabetes


A terrible illness struck me a few months after my diagnosis. The story is fairly complicated, but here are the essential elements: I participated in a Phase II Clinical Trial for a drug that was supposed to make diabetic life easier; the drug made me sick; a flurry of illnesses followed; I ended up with mono.

During those bed-ridden days, my fever climbed to 105 degrees Fahrenheit and my grip on reality became weak. I don’t think I actually hallucinated, but it makes a better story to say that I did. So, I hallucinated. The most interesting part of the experience, however, was the fact that my blood sugars stayed almost-perfect the whole time.

This fact contradicted the diabetic wisdom that states that sickness and fever will drive one’s blood sugars into the stratosphere. I never bolused for what little food I could manage, and still my blood sugar levels hovered around 140. Hardly any insulin entered my body. Was I hallucinating? No: I was in the Honeymoon Phase.

The Honeymoon Phase, or “Honeymoon Period,” which can last for as long as a year, occurs when the body makes a partial recovery from its autoimmune attack. If you want to approach a thorough comprehension of type 1 diabetes (T1D), or if you know anyone who was diagnosed recently, it’s important to understand what’s going on here.

But in order to understand the Honeymoon Phase, we must take a look at T1D’s pathogenesis, or, how the disease develops. Side note: I will give one whole dollar to anyone who can use “pathogenesis” in a Scrabble game.

As you probably know, type I diabetes strikes when the body’s immune system decides that the pancreas’s Islets of Langerhans (more particularly, the beta cells within those Islets) are enemies and must be destroyed. Why the immune system decides that the beta cells are enemies that must be destroyed is a complicated question with no clear answer.

Beta cells secrete insulin, and so when they’re slain by T-cells and various other lymphocyte tough guys, the person with diabetes lacks the basic amount of insulin required to go on living. Unless she introduces artificial insulin into her body, the person with diabetes will die.

This sounds dire, but T1D diagnosis does not necessarily mean that the Islets of Langerhans are toast. Most people with diabetes retain pockets of living beta cells for a long time after their diagnosis. At the time of diagnosis, they are suffering terribly. When artificial insulin lowers the diabetic’s blood sugars, her surviving beta cells wake up, and the Honeymoon Phase can begin.

This lowering of blood sugars does two things. First, it puts less stress on the surviving beta cells by removing the need for them to compensate for missing insulin. Second, since glucose is toxic to your cells, and produces an inflammatory response, lowering blood-glucose allows the beta cells to function in an environment that is literally less toxic.

In these ways, artificial insulin causes the body to partially recover. Once the glucose toxicity around the Islets of Langerhans weakens, the beta cells begin to release larger puffs of endogenous insulin again. While this lasts, a person with diabetes is in the Honeymoon Phase.

My Honeymoon Phase spanned a school year during which I played three sports. The shock and attrition of my new diabetic life certainly hit me, but my rejuvenated beta cells softened the blow. The Honeymoon Phase felt like a small mercy. For a few months, the cellular bottle rockets that sent my blood sugars screaming into the four or five hundreds burned slowly, and possessed longer fuses. During this period, diabetes seemed eminently manageable.

For some people with diabetes, the instability of the Honeymoon Phase can become exhausting. As the beta cells make their partial recovery, one’s insulin needs decrease, and the new person with diabetes can find herself chasing low blood sugars. Indeed, some of the most fearsome lows of my life struck early in the Honeymoon Phase.

Certain blog posts articulate a desire for the honeymoon phase to end as quickly as possible so that the person with diabetes can get down to the real business of calculating their more permanent insulin-carb ratios. In the straightforwardly titled article “I Hate My Son’s Honeymoon Period,” Tara Bryant-Gray suggests that dealing with an “erratic, failing pancreas” is too much trouble. She says that if she could “turn off his pancreas,” she would.

It’s clear, then, that the Honeymoon Phase is not an uncomplicated blessing. Still, despite its discomforts, I think it’s better to hope that those last beta cells cling to life for as long as possible. People with diabetes can use all the help they can get, and the rarer one’s high blood sugars, the lower the risk of later complications.

Some researchers are looking for ways to prolong the Honeymoon Phase. Some results have suggested that a gluten-free diet will do the trick (NCBI); others have indicated that Vitamin D3 might help (JAMA). These measures are only momentary stays against T1D’s full onset.

The Honeymoon Phase possesses a name that is misleading at best; at worst, it’s bitterly ironic. Besides the knowledge that one’s self-care is slightly easier right now, there isn’t much to enjoy in it. Still, for those of us who have gone through the Honeymoon Phase, I think our brave, dying beta cells deserve a modicum of gratitude for continuing to do their thing while suffering under a brutal chemical siege. Until we find a cure, diabetes has given us this strange, small mercy.

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WRITTEN BY Forester McClatchey, POSTED 05/29/17, UPDATED 08/04/23

Forester McClatchey is a writer from Atlanta, GA, and a recent graduate of the MFA Program at the University of Florida. You can find his poetry at http://www.forestermcclatchey.com/ and hear his music at https://qcurius.com.