China-Japan Friendship Hospital Li Guangwei 1, the concept of type 2 diabetes honeymoon period honeymoon period generally refers to a period of time after insulin therapy in type 1 patients with little insulin use or even stop using, for type 2 also has a honeymoon period, is the Israeli medical doctor Erol Cerasi, he used insulin therapy in 13 cases of newly diagnosed type 2 diabetes, there are 9 cases without insulin and maintain good blood sugar 9 -50 months. Qiu Zhanjun, Department of Emergency Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine 2, the connection between honeymoon period and insulin function ——– first time insulin secretion is more important The honeymoon period of type 1 diabetes is related to a number of factors: the older the patient is, the lighter the disease, the better and longer the remission of the disease during the honeymoon period for those with negative anti islet cell antibodies or lower titers. type 2 diabetes is more important in relation to the patient’s first time insulin secretion. Insulin at this time plays a particularly important role in postprandial glucose homeostasis. It inhibits hepatic glucose production, which is the earliest defect in the progression of diabetes. In recent years the diabetes community has paid increasing attention to the role of first tense insulin secretion in the treatment. In fact, in the early stages of diabetes and during the period of reduced glucose tolerance, the second chronotropic insulin secretion increases, but the first chronotropic insulin secretion has disappeared. In terms of fasting blood glucose, the first insulin secretion is depressed at 5.6 mmol/L, while the first insulin secretion disappears at 6.1 mmol/L. The recovery of the first chronotropic secretion means that the blood glucose level may remain normal or near normal without any treatment.3. The possibility of recovery of the first chronotropic insulin secretion Glucotoxicity refers to the decrease of insulin secretion capacity and glucose perception of pancreatic B cells exposed to high glucose. Several domestic and foreign reports a considerable number of newly diagnosed type 2 diabetic patients, the first time insulin secretion is reproducible. 4, which patients have more hope to induce the honeymoon phase, how much hope to occur honeymoon phase? type 1 diabetes at the beginning of the onset of insulin given 2-3 or more times, after several weeks, aggressive glycemic control can make most patients enter the honeymoon phase. This is because complete B-cell destruction does not occur until 3 years after onset in most children, or even longer, and is more pronounced and slow in older individuals. type 2 patients are more likely to trigger the honeymoon phase, and those with non-wasting, short disease duration, and low doses of insulin use gain the honeymoon phase for longer. The 6-month remission rate in domestic patients with newly diagnosed type 2 by Kee and Weng is about 70%.5. To what extent can glycemic control correct glucotoxicity to induce honeymoon phase? The available type 1 diabetes studies have shown that the toxicity of hyperglycemia can only be eliminated by controlling blood glucose in the normal range. Normalization of blood glucose levels increases residual B-cell insulin secretion and improves insulin sensitivity, and insulin therapy for type 2 diabetes has also shown that simply decreasing blood glucose levels to a certain extent may increase insulin secretion in the second tense, which does not induce a honeymoon phase. A necessary condition for inducing prolonged remission is the restoration of the first chronological insulin secretion to a large extent. The authorities believe that to achieve this effect, the insulin dose to start treatment may be large, and more importantly, the insulin adjustment is based on a minimum of 4 daily blood glucose tests with the goal of keeping preprandial glucose in the normal range, for which it is necessary to contact them by phone at least 3 weeks before treatment. 6. How long does this intensification take? In the study, islet B-cell function remained poor during the first week of rapid glycemic correction with intensive treatment, improved during the third week, however, there was no further change after 3 months. Insulin sensitivity did not improve significantly either at 3 weeks or at 3 months. This shows the short-term nature of this treatment, whose course does not need to be long.7. Which method is used to induce the honeymoon phase? It should be said that insulin therapy is not the only way to reduce glucotoxicity and improve insulin secretion. Any method that can effectively lower blood sugar and correct the toxicity of hyperglycemia has the potential to significantly improve B-cell function. The goal of treatment is to bring blood glucose to the target, independent of which method is used. The simpler the method, the better, as long as the target can be achieved. However, it cannot be denied that treatment with an insulin pump is most likely to mimic physiological insulin secretion and result in satisfactory achievement of blood glucose targets with fewer hypoglycemia. Insulin resistance is the main cause of type 2 diabetes, and insulin resistance leads to high insulin dosage, and high doses of insulin can bring about hyperinsulinemia and weight gain. Insulin doses can be reduced by combining with oral antidiabetic drugs that improve insulin resistance. The same efficacy has been reported with the application of sulfonylureas in unmedicated type 2 diabetes. The fasting glucose/insulin ratio increased 3-fold at 1 week.8. The significance of inducing a “honeymoon period” The emergence of a “honeymoon period” in the treatment of type 2 diabetes has brought a lot of hope and temptation to doctors and patients. One has to consider whether the restoration of insulin secretion in the first hour should be a goal of treatment.
In 1997, Dr. Erol Cerasi of Israel first introduced the concept of the “honeymoon phase” in type 2 diabetes! He treated 13 cases of newly diagnosed type 2 diabetes with insulin, and 9 cases maintained good blood sugar for 9-50 months without insulin. The method used: insulin pump for 2 weeks. In some of these cases the insulin pump was repeated 2-3 times! //4 cases were not able to enter the “honeymoon period”. The chance of induction into the “honeymoon phase” was: 69.23% Related review: 1. 1996 Dr. Banerji MA reported in Diabetes. 1996 Mar;45(3):337-41. remission in black newly diagnosed NIDDM subjects. A group of 79 newly diagnosed type 2 diabetes mellitus treated with drugs (including insulin and sulfonylureas) for a short period of time and after complete discontinuation of the drugs, their own blood glucose was also well controlled for a certain period of time.2. 2004 Dr. Weng Jianping, China, in DIABETES CARE, VOLUME 27, NUMBER 11, NOVEMBER 2004. reported: Induction of Long-term Glycemic Control in Newly Diagnosed Type 2 Diabetic Patients Is Associated With Improvement of B-Cell Function A group of 126 newly diagnosed type 2 diabetic patients treated with insulin pump for 2 weeks and completely discontinued their medication had good control of their own blood glucose for a certain period of time. It was proposed that the recovery of insulin 1 phase secretion was the reason for (“honeymoon phase”) remission! //There were 12 cases that did not enter the “honeymoon phase”. The chance of induction into the “honeymoon phase” was 91.30%.3 In 2007, Dr. Guangwei Li of China reported in the Journal of Practical Diabetes 2007, Vol. 04. 4. Case report: Newly diagnosed type 2 diabetes and its honeymoon period. 5. The “honeymoon period” effect. These patients often have amazing exercise habits! 6. (Release date: 2008-12-11) http://www.dxy.cn/bbs/post/view?bid=92&id=13442595&sty=3&keywords=1480使用的方法: insulin pump 11 days “” changed to Novolin 30R total 87 days [half an hour before meals subcutaneous injection: from morning. 20U, 18U at night; gradually reduce the dose to morning: 8U, 6U at night] (combined with Gevalt 500mg/day, counting 26 days) adhere to control diet and exercise every day! FBS: 4.9mmol/L (2008-12-6) The studies listed earlier in 1-5 are often monotherapy on the induction of the “honeymoon phase ” effect! And the treatment of the patient in this case reflects exactly one combination of the aforementioned studies 1-5! So, the new treatment idea for newly diagnosed type 2 diabetes is: in order to maximize the salvage of insulin function and achieve the restoration of insulin 1 phase secretion function, use your most powerful set of “powerful combinations” – and don’t stop until you achieve your goal! If, after your treatment, the patient cannot be induced to enter the “honeymoon phase”! Consider first what else is not in place! The following is the trend of the distribution of 164 FBS measured by the patient after stopping insulin: FBS