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I will be posting this on the main website but thought I'd post it here too.
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Diabetes in Dogs: Honeymooning
Although it’s not common, dogs recently diagnosed with diabetes can go through a “honeymoon” period during which their ability to make insulin returns for a while.
Diabetes is dogs is akin to Type 1 diabetes in people. The immune system attacks cells in the pancreas that make insulin, destroying them. As time goes on, more and more cells are destroyed and the ones that are still functioning work harder to take up the slack. Eventually, the cells that are left can’t keep up and your dog starts to show the symptoms of diabetes as his blood sugar rises.
With or without treatment, the auto-immune attack on the cells will continue. So eventually, even if you treat him with insulin right away, he will lose all of his beta cells and will completely lose the ability to make insulin.
Honeymooning can occur when your dog’s diabetes is diagnosed very soon after it develops—early enough that some insulin-producing cells remain. Injecting insulin improves the blood sugar and takes the pressure off of the pancreas, allowing the overworked cells to “rest” and improving the body’s sensitivity to insulin.
Not all diabetic people or dogs go through a honeymoon period. And because dogs often aren’t diagnosed very early, honeymooning is even less common in dogs than in people. Over six years of participating on forums for diabetic dogs, I have seen only a couple of dogs who might have been honeymooning. Our dog was unusual in that he honeymooned for six months. And although it preserved his eyesight for that six months (he quickly developed cataracts when his blood sugar levels went up), his extensive honeymooning period complicated his treatment afterward because it disguised the fact that he did not make good use of the insulin he was being given (see Chris’ case study for information on his problems regulating).
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Chris’ Experience with Honeymooning
Our diabetic dog Chris went through a honeymoon period of about six months. It started with a small dose of prednisone, a steroid, for his allergies and almost immediately he began consuming large amounts of water. When his drinking didn’t return to normal once the steroid was discontinued, he was checked for diabetes (September 6, 2003).
Chris weighed 58 pounds when diagnosed and was started on insulin at one quarter unit per pound—14 units—twice daily.
The results of his first curve a week later looked like he didn’t have diabetes at all. His blood sugar ranged from 71 to 109 mg/dl. So his dose was reduced to 12 units. A spot check a week later was 168 mg/dl.
On October 9, one month after he was diagnosed, his blood sugar at the vet was 86 and his fructosamine test showed blood sugar akin to a nondiabetic dog. It was 327, right in the middle of the normal reference range. At that point, we tried discontinuing his insulin altogether for a week.
On October 15, six days after stopping his insulin injections, Chris’ blood sugar was 225 five hours after eating. He was put on 5 units of insulin twice a day (almost two thirds less than his starting dose). A month later and two months into his diabetes, his blood sugar ranged from 139 to 163 and the fructosamine score was 410, which is on the low end of Good Control for a diabetic dog so the dose was maintained at 5 units.
We cruised along on 5 units twice a day for quite a while.
Chris had some spot checks of his blood sugar in the first half of January, 2004, that showed his blood sugar in the low 90s. On January 26, about 4.5 months after his diagnosis, he had a curve and his blood sugar was again low, ranging from 68 to 96. So the dose was reduced from 5 to 3 units twice a day.
In early February, his blood sugar still seemed low and we tried three or four days of no insulin but he didn’t do well with none. On February 11 on 3 units twice a day his blood sugar was 71 mg/dl and his dose was reduced to 2 units once a day. Two weeks later his blood sugar was 80 on that tiny amount of insulin. So we went to 1 unit once a day! And he did well with that for about two weeks. On March 3, 2004, his blood sugar was 160.
Interestingly, the honeymoon started coming to an end just about the time we had reduced his dose to the smallest amount possible. On March 9, his blood sugar was up to 243. By March 23, his blood sugar was 503! He was put on 2 units twice a day and had a curve done on April 8, seven months almost to the day since his diagnosis. His blood sugar ranged from 447 to 560… the honeymoon was over.
___________
Diabetes in Dogs: Honeymooning
Although it’s not common, dogs recently diagnosed with diabetes can go through a “honeymoon” period during which their ability to make insulin returns for a while.
Diabetes is dogs is akin to Type 1 diabetes in people. The immune system attacks cells in the pancreas that make insulin, destroying them. As time goes on, more and more cells are destroyed and the ones that are still functioning work harder to take up the slack. Eventually, the cells that are left can’t keep up and your dog starts to show the symptoms of diabetes as his blood sugar rises.
With or without treatment, the auto-immune attack on the cells will continue. So eventually, even if you treat him with insulin right away, he will lose all of his beta cells and will completely lose the ability to make insulin.
Honeymooning can occur when your dog’s diabetes is diagnosed very soon after it develops—early enough that some insulin-producing cells remain. Injecting insulin improves the blood sugar and takes the pressure off of the pancreas, allowing the overworked cells to “rest” and improving the body’s sensitivity to insulin.
ADA News and Research:
“The amount of insulin required to reduce the blood glucose levels of newly diagnosed type I diabetic patients to normal is very high. However, within weeks of diagnosis, the insulin requirement is substantially reduced in many patients. This period of low insulin requirement has been termed “the 'honeymoon period.”
Source Link for above
Definition of Honeymooning by the ADA:
Some people with type 1 diabetes experience a brief remission called the “honeymoon period.” During this time their pancreas may still secrete some insulin. Over time, this secretion stops and as this happens, the child will require more insulin from injections. The honeymoon period can last weeks, months, or even up to a year or more.
Source Link for above
So after weeks or months, there are no insulin-producing cells left and the honeymoon ends. At which point the dog depends entirely on injected insulin.“The amount of insulin required to reduce the blood glucose levels of newly diagnosed type I diabetic patients to normal is very high. However, within weeks of diagnosis, the insulin requirement is substantially reduced in many patients. This period of low insulin requirement has been termed “the 'honeymoon period.”
Source Link for above
Definition of Honeymooning by the ADA:
Some people with type 1 diabetes experience a brief remission called the “honeymoon period.” During this time their pancreas may still secrete some insulin. Over time, this secretion stops and as this happens, the child will require more insulin from injections. The honeymoon period can last weeks, months, or even up to a year or more.
Source Link for above
Not all diabetic people or dogs go through a honeymoon period. And because dogs often aren’t diagnosed very early, honeymooning is even less common in dogs than in people. Over six years of participating on forums for diabetic dogs, I have seen only a couple of dogs who might have been honeymooning. Our dog was unusual in that he honeymooned for six months. And although it preserved his eyesight for that six months (he quickly developed cataracts when his blood sugar levels went up), his extensive honeymooning period complicated his treatment afterward because it disguised the fact that he did not make good use of the insulin he was being given (see Chris’ case study for information on his problems regulating).
_________
Chris’ Experience with Honeymooning
Our diabetic dog Chris went through a honeymoon period of about six months. It started with a small dose of prednisone, a steroid, for his allergies and almost immediately he began consuming large amounts of water. When his drinking didn’t return to normal once the steroid was discontinued, he was checked for diabetes (September 6, 2003).
Chris weighed 58 pounds when diagnosed and was started on insulin at one quarter unit per pound—14 units—twice daily.
The results of his first curve a week later looked like he didn’t have diabetes at all. His blood sugar ranged from 71 to 109 mg/dl. So his dose was reduced to 12 units. A spot check a week later was 168 mg/dl.
On October 9, one month after he was diagnosed, his blood sugar at the vet was 86 and his fructosamine test showed blood sugar akin to a nondiabetic dog. It was 327, right in the middle of the normal reference range. At that point, we tried discontinuing his insulin altogether for a week.
On October 15, six days after stopping his insulin injections, Chris’ blood sugar was 225 five hours after eating. He was put on 5 units of insulin twice a day (almost two thirds less than his starting dose). A month later and two months into his diabetes, his blood sugar ranged from 139 to 163 and the fructosamine score was 410, which is on the low end of Good Control for a diabetic dog so the dose was maintained at 5 units.
We cruised along on 5 units twice a day for quite a while.
Chris had some spot checks of his blood sugar in the first half of January, 2004, that showed his blood sugar in the low 90s. On January 26, about 4.5 months after his diagnosis, he had a curve and his blood sugar was again low, ranging from 68 to 96. So the dose was reduced from 5 to 3 units twice a day.
In early February, his blood sugar still seemed low and we tried three or four days of no insulin but he didn’t do well with none. On February 11 on 3 units twice a day his blood sugar was 71 mg/dl and his dose was reduced to 2 units once a day. Two weeks later his blood sugar was 80 on that tiny amount of insulin. So we went to 1 unit once a day! And he did well with that for about two weeks. On March 3, 2004, his blood sugar was 160.
Interestingly, the honeymoon started coming to an end just about the time we had reduced his dose to the smallest amount possible. On March 9, his blood sugar was up to 243. By March 23, his blood sugar was 503! He was put on 2 units twice a day and had a curve done on April 8, seven months almost to the day since his diagnosis. His blood sugar ranged from 447 to 560… the honeymoon was over.
Didn't take long to reconstruct the sequence from 2003/2004.
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