Honeymoon phase

In type 1 DM, the average daily insulin requirement is 0.5 to 0.6 units/kg. Requirements may fall to 0.1 to 0.4 units/kg in the honeymoon phase. Higher doses (0.5 to 1 unit/kg) are warranted during acute illness or ketosis. In type 2 DM, a dosage range of 0.7 to 2.5 units/kg is often required for patients with significant insulin resistance. 

Type 1 DM is characterized by an absolute deficiency of insulin. Most often this is the result of an immune-mediated destruction of pancreatic p cells, but rare unknown or idiopathic processes may contribute. What is evident are four main features (1) a long preclinical period marked by the presence of immune markers when /3-cell destruction is thought to occur (2) hyperglycemia when 80% to 90% of p cells are destroyed (3) transient remission (the so-called, honeymoon phase) and (4) established disease with associated risks for complications and death. Unknown is whether there is one or more inciting factors (e.g., cow s milk, or viral, dietary, or other environmental exposure) that initiate the autoimmune process (Fig. 72-4). 

Her parents should be warned that she might experience a honeymoon period in the first few months after diagnosis, which means that her insulin requirements could temporarily drop off dramatically. Around a quarter of all patients who get type 1 diabetes develop a honeymoon period within days or weeks of the onset of treatment. It is as if the patient has gone into remission and this can be confusing for the patient/carer as it would appear that the condition has corrected itself. Some patients actually require no insulin during this phase which may last for weeks or months however, it is usually best to keep treating with insulin even if the requirements are negligible to avoid possible insulin... 

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