Happy Saturday! Welcome to Ask D’Mine, our weekly advice column hosted by veteran type 1, diabetes author and community educator Wil Dubois. This week, Wil takes on the Evolution of Diabetes, as it occurs in your body over time — and you know, the end of the honeymoon phase!

{Got your own questions? Email us at AskDMine@diabetesmine.com}


Lisa, type 1 from Texas, writes: Hi! I’m 27 and was diagnosed with diabetes last summer. When I was first diagnosed, my insulin-to-carb ratio was 1:30. By the beginning of this year, it had increased to 1:15 and has since decreased to 1:26. I’m wondering what causes these ratios to change and whether it’s normal for them to change so much? 

Wil@Ask D’Mine answers: If no one else has said it yet, Welcome to the family! Now, as to your bouncy-bouncy carb ratios, yes, that’s normal early on. Frustrating. But normal. The good news is that it’ll settle down. Here’s what’s going on: you and your diabetes have just hooked up. The relationship is new, and turbulent. You really haven’t gotten to know each other very well just yet. You’re in what’s charmingly called the honeymoon phase. Don’t get too excited. Diabetes honeymoons don’t involve sex and romance. They’re more about death and destruction.

The diabetes honeymoon is the time period between when your immune system has killed enough of your beta cells to make you sick, and when it wipes out the last of them. In someone your age, the honeymoon usually lasts around a year, but could be up to two years. During this time, your body still produces some, but not enough, insulin.

How does this affect your carb ratios? So, just making up some numbers here, let’s pretend that early in your honeymoon your bod was still able to make 50% of the first-phase insulin needed to cover a meal. That means you’ll need to inject or pump the other half, right? Let’s also assume that you need a typical type 1 insulin-to-carb (IC) ratio of 1:15—meaning that one unit of insulin “covers” 15 grams of carbs. If your body is taking care of half of the job and you are importing the other half, a 1:30 ratio will be perfect to make up the difference! For a short time.

Because your miswired immune system is relentless. It’s fully embarked on a ruthless campaign of beta cell genocide. As the immune system progressively wipes out the beta cells, your body’s ability to produce insulin drops, and you need to import more and more insulin from outside. As your honeymoon progresses, it’s typical for the IC ratio to drop accordingly. Memo to the math impaired: smaller IC numbers deliver progressively larger amounts of insulin, as IC ratios are ass-backward from normal logic.

So that explains why you went from 1:30 to 1:15. Why the hell did it go back up to 1:26? Well, your beta cells might have rallied at the last minute. That happens. The honeymoon isn’t over yet, baby!

Or… there’s another possible answer. It can be more than a little difficult to sort out cause and effect between blood sugar and insulin. For instance, if you’re high in the morning: is it because you don’t have enough basal insulin overnight, or is it because you didn’t take enough fast-acting insulin for dinner the night before? It can get even more complicated during the day when you have overlapping basal, meal insulin, and insulin for corrections. It takes time to sort out what insulin is doing what, and to get all the various doses, rates, and ratios sorted out. Oh, and all of those numbers are commonly different at different times of the day, too. It’s the ultimate chicken-or-egg nightmare.

But once the honeymoon is over, one less variable is in the mix, and it gets easier to sort everything out. Maybe. Because, speaking of honeymoons…


Mandy, type 3 from Michigan, writes: My son has had diabetes for more than a year… how will I know when the honeymoon is over? I’ve talked with other parents who’ve all had different experiences on how long their kids’ honeymoon periods lasted. Is there any specific criteria that doctors use?

Wil@Ask D’Mine answers: You’ll know when the honeymoon is over when his blood sugars settle down a little bit and you’re not making almost daily changes in his basal insulin. Honeymoons, on average, range six months to one year. However, in some people it can be much shorter, weeks or a few months; and in rare cases two-year honeymoons are seen. Generally, the younger you are at diagnosis, the shorter the honeymoon; and the older you are at diagnosis, the longer the honeymoon.

As to criteria, frankly, it’s over when it’s over. In theory, your doc could order insulin levels and c-peptide labs and the results of those two tests together would show when the insulin production reaches zero. That said, most docs don’t bother. It serves no real medical need. An official declaration of beta cell death isn’t really needed. And the results might also be misleading, because in the final phases of the honeymoon phase the pancreas sometimes “wakes up” again for a little while like the classic Monty Python I’m Not Dead Yet episode. So even if you had absolutely zero insulin one week… FALSE ALARM! The next week the pancreas might squeeze out a little more.

And to make this even more complicated, it may prove that the honeymoon never ends after all. How frickin’ romantic. Read on.

The common wisdom for years and years and years has been that within a year or two after diagnosis, you’ll have zero insulin production. The pancreas will be dead and gone. End of story. (Actually, our immune systems kill off the tiny little insulin-producing beta cells in one dark corner of the pancreas, the rest of the pancreas is still very much alive and well.) But it’s proving to be not quite so simple.

Some researchers now believe the beta cells, like some sort of microscopic dandelions, keep trying to grow back. But, as soon as they do, the immune system comes around with a big bottle of Roundup and zaps them dead again. So it’s a never-ending battle.

If this proves to be true, it would explain why some of us type 1s have such a devilishly difficult time trying to keep our blood sugar under control: we’re shooting at a moving target. Some days/weeks/months our bodies might be producing some insulin and other days/weeks/months it isn’t.

Think of it. The cells keep trying to grow back, but the immune system just keeps mowing them down again. We might all be in a consent state of low-grade honeymoon. The white blood cells have the upper hand and have decimated the bulk of the beta cells, but the little troopers keep trying to come back. Their numbers are so few they can barely poke their heads out of the sand before they are wiped out. Still, maybe they manage to squirt out a little insulin before their untimely deaths.

So where does that leave us? Wouldn’t it be easier if the damn things just stayed dead? Easier in the moment, perhaps. But this irritating fact that makes today’s day-to-day control a challenge may well hold the keys to a future cure.

If the beta cells keep trying to grow back, it might mean that if we can teach the immune system to recognize them as part of the home team, we can cure type 1. It would look something like this: Fix the immune system. Let the beta cells grow back. Presto! Blood sugar homeostasis returns. Diabetes goes away. Simple.

All that will be left to do is meet at Krispy Kreme for breakfast, then we’ll all go out and throw our meters, syringes, pumps, and pens into a bonfire.

It’ll make the Burning Man festival look like a side show.

But in the meantime, we’ll just have to keep on truckin’.


This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.