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Brittle Diabetes In The Elderly

Late Stage Complications Of Diabetes And Insulin Resistance

Late Stage Complications Of Diabetes And Insulin Resistance

1Department of Microbiology, Chaitanya Postgraduate College, Kakatiya University, Warangal, India 2Department of Biotechnology, Presidency College, Bangalore University, India *Corresponding Author: Department Of Microbiology, Chaitanya Postgraduate College affiliated to Kakatiya University, Warangal, India E-mail: [email protected] Citation: Soumya D, Srilatha B (2011) Late Stage Complications of Diabetes and Insulin Resistance. J Diabetes Metab 2:167. doi:10.4172/2155-6156.1000167 Copyright: © 2011 Soumya D, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Visit for more related articles at Journal of Diabetes & Metabolism Abstract Diabetes mellitus is considered one of the main threats to human health in the 21st century. Diabetes is a metabolic disorder or a chronic condition where the sugar levels in blood are high. Diabetes is associated with long-term complications that affect almost every part of the body and often leads to blindness, heart and blood vessel disease, stroke, kidney failure, amputations, and nerve damage. Also it is associated with significantly accelerated rates of several debilitating microvascular complications such as nephropathy, retinopathy, and neuropathy, and macrovascular complications such as atherosclerosis and stroke. In the present article it has been discussed about the resistance of insulin and its consequences in diabetic patients. Insulin resistance results in various disorders. Metabolic syndrome is predicted to become a major public health problem in many developed, as well as developing countries. Keywords Diabetes; Complications Continue reading >>

Brittle Diabetes In The Elderly

Brittle Diabetes In The Elderly

BackgroundBrittle diabetes is frequently attributed to psychological stressors causing insulin omission in young women with Type 1 diabetes. It has received little attention in the recent medical literature.Case reportWe report the case of an 87yearold woman who had recurrent episodes of unexplained diabetic ketoacidosis. Despite frequent inpatient monitoring of capillary glucose, her blood glucose levels remained erratic. She experienced a total of 12 episodes of ketoacidosis (some occurring during hospitalization), with 11 episodes occurring over a 3month period. Several episodes of ketoacidosis required care in a highdependency unit and up to 32 h of intravenous insulin and fluids. Extensive investigations failed to identify any underlying cause of the recurrent ketoacidosis. Ultimately, the introduction of a continuous subcutaneous insulin infusion pump resulted in improved glycaemic control and avoided the need for further hospitalizations.ConclusionIndividuals of advanced age can benefit from insulin pump therapy. The original definition of brittle diabetes referred to patients whose lives were constantly disrupted by episodes of hypo or hyperglycaemia. Our case reminds us that this clinical entity can result from altered biology and is not always related to psychological stressors.This article is protected by copyright. All rights reserved. Severely unstable, or brittle, diabetes can be disruptive to patients, carers and diabetes care teams. The peak age-group for brittle diabetes is 15-30, but there are reports of its occurrence in much older patients. To explore the characteristics and cause of brittle instability perceived by diabetologists in elderly patients we circulated a questionnaire to all UK hospital diabetic clinics for adults. 130 (56%) of 231 repli Continue reading >>

Brittle Diabetes Facts

Brittle Diabetes Facts

Unstable and Brittle Diabetes (Advances in Diabetes) The concept of brittle diabetes was first introduced in the 1940s to categorize people with type 1 diabetes who didnt seem to respond well to insulin treatment. In the mid-20th century, before personal blood glucose meters became available, blood glucose measurements were hard to come by, so the defining features of brittle diabetes were unexpected episodes of low blood glucose (hypoglycemia) as well as recurrent diabetic ketoacidosis (DKA), a severe complication of very high blood glucose. Today, people have a much more detailed picture of how blood glucose changes over the course of a day, thanks to blood glucose meters and continuous glucose monitors. Because blood glucose fluctuations now are easier to track, people may be amazed at just how frequently levels vary. The Other Side of the Driveway: A Diabetics Point of View One of the most prominent features of diabetes is its uniqueness. No two diabetics respond in exactly the same way to their food, insulin, or exercise, and no two individuals, even if they show the same glucose test results, will experience precisely the same complications. The disease is, by definition, unpredictable. Still, making allowance for surprises, we know the effects of more insulin, less insulin, more exercise, less exercise, more food, etc. For most diabetics, most of the time, the rules work. If I do this, or do not do that, I can expect this result. But there is a body of individuals for whom the rules do not appear to apply, and to them is often applied the adjective brittle. The New Glucose Revolution What Makes My Blood Glucose Go Up . . . and Down?: 101 Frequently Asked Questions About Your Blood Glucose Levels Brittle describes a severe form of diabetes. Its characterized by a Continue reading >>

Diabetes And The Older Patient

Diabetes And The Older Patient

Objectives 1. Review treatment options in caring for older patients with diabetes 2. Understand risks of hyperglycemia and hypoglycemia in older patients 3. Appreciate importance of cardiovascular risk reduction in older patients with diabetes by treating hypertension and hyperlipidemia 4. Gain awareness of association: diabetes, HTN, and vascular risk factors with dementia 5. Discuss the Treatment-Risk Paradox and how this applies to medical management in older patients Outline Prevalence Acute complications Treatment options and goals Risks of longstanding diabetes Reducing cardiovascular events: treating hypertension and dyslipidemia Dementia: association with cardiovascular risk factors; ?can we prevent it? The Treatment-Risk Paradox: Paper review Case Study #1 78 y/o nursing home resident presents for evaluation of recurrent severe hypoglycemia. Diagnosed age 65 , treated with sulfonylurea without response, subsequently treated with insulin, currently 70/30 14 u in AM, 10 u QHS. Logs: 4-6 readings/day, ranging from 30’s (usually in afternoon or early AM) to mid 500’s, average 195. PE: 61â€, 98 lbs, 138/66, 82. Exam unremarkable A1c=8.6%; Creatinine=1.3, TC=150, HDL=70, LDL=70, TG=50 This is a case of type 1 diabetes. Type 1 diabetes can present at any age. Review characteristics of type 1 and type 2 diabetes discussed in lecture. Case study #2 92 year old woman comes to you on glyburide at 10 mg a day. She, after much discusssion, is unable to check her own glucose. She is very afraid of having a hypoglycemic reaction as she lives alone. Her Hgb A1C is currently 9.8%. She is otherwise healthy, on no other medications, and is completely active and independent. Case # 2 What is the goal of treatment in this woman? What are the risks and the benefits Continue reading >>

Medical Definition Of Unstable Diabetes

Medical Definition Of Unstable Diabetes

Amputations. INVOKANA® may increase your risk of lower-limb amputations. Amputations mainly involve removal of the toe or part of the foot; however, amputations involving the leg, below and above the knee, have also occurred. Some people had more than one amputation, some on both sides of the body. You may be at a higher risk of lower-limb amputation if you: have a history of amputation, have heart disease or are at risk for heart disease, have had blocked or narrowed blood vessels (usually in leg), have damage to the nerves (neuropathy) in the leg, or have had diabetic foot ulcers or sores. Call your doctor right away if you have new pain or tenderness, any sores, ulcers, or infections in your leg or foot. Your doctor may decide to stop your INVOKANA®. Talk to your doctor about proper foot care Dehydration. INVOKANA® can cause some people to become dehydrated (the loss of too much body water), which may cause you to feel dizzy, faint, lightheaded, or weak, especially when you stand up (orthostatic hypotension). You may be at higher risk of dehydration if you have low blood pressure, take medicines to lower your blood pressure (including diuretics [water pills]), are on a low sodium (salt) diet, have kidney problems, or are 65 years of age or older Talk to your doctor about what to do if you get symptoms of a yeast infection of the vagina or penis. Before you take INVOKANA®, tell your doctor if you have a history of amputation; heart disease or are at risk for heart disease; blocked or narrowed blood vessels (usually in leg); damage to the nerves (neuropathy) of your leg; diabetic foot ulcers or sores; kidney problems; liver problems; history of urinary tract infections or problems with urination; are on a low sodium (salt) diet; are going to have surgery; are eatin Continue reading >>

Frequently Asked Questions

Frequently Asked Questions

The Dumbest & Smartest Things A Doctor Ever Told Me I eat a low fat diet, so why is my cholesterol level still high? Why are my blood sugars higher in the morning than when I go to bed the night before? This typically occurs due to the dawn phenomenon. The dawn phenomenon is the rise in blood glucose levels in the dawn (that is, the morning) due to excessive release of glucose from the liver into the blood. Here is a graph of a person’s blood glucose readings measured with a device (a “continuous glucose monitor”) that automatically measures the body’s glucose level about 300 times per day (each colour represents a different day): As you can see in the preceding graph, every day starting at about 3am this person’s glucose levels started to go up. This individual, like so very many others living with diabetes who have high blood glucose levels first thing in the morning, blamed themselves and attributed their elevated morning blood glucose to having overeaten or snacked the night before. Not so! What they (and you) eat at bedtime (or suppertime) seldom is a significant factor in leading to high blood glucose levels the next morning; heck, the food you ate the night before is long since digested, absorbed into the body, and metabolized well before the following morning’s breakfast. This graph nicely illustrates that point. One colourful term for the liver’s tendency to release glucose into the blood overnight is a liver leak. How much sugar (glucose) gets released from the liver if you have the dawn phenomenon? How about this: Almost as much as is contained in TWO CANS OF COLA! If you have the dawn phenomenon this is something that is not simply to be accepted. Rather, your therapy should be adjusted to fight it so that your blood glucose levels are kept w Continue reading >>

Brittle Diabetes In The Elderly | Docguide

Brittle Diabetes In The Elderly | Docguide

Source: Neurology | Posted 16 years ago Read/Add Comments | Email This | Print This Brittle diabetes is now more likely to be encountered in the elderly following the growing use if insulin in this age group, say researchers in the United Kingdom. Previously, this severe unstable form of diabetes was more commonly encountered in late adolescence and twenties. Consequently, it had proved challenging to patients, their families, practitioners and their teams. There has now been an increase in brittle diabetes among the more elderly patients. Clinicians at the University of Liverpool in England designed a study to investigate characteristics and causes of brittle diabetes through a questionnaire sent to all diabetic clinics for the elderly in the United Kingdom. Of the 231 approached, 130 (56 percent) replied. Eventually, researchers reported on 55 patients who fulfilled the criteria relative to brittle diabetes. This included being age 60 years or above, receiving insulin therapy, and experiencing life- disrupting glycemic instability associated with frequents or longs term admissions to hospital. In addition, a research nurse visiting relevant clinics received further information. Among the patients, the mean age was 74 years (range 60-89) and 71 percent were females. Classification of the brittleness determined that mixed glycemic instability existed in 22 (44 percent), 16 (29 percent had recurrent ketoacidosis and 15 or 27 percent suffered recurrent hypoglycemia. Two patients were unable to be classified due to insufficient information. The brittleness was judged by the diabetes team to be of multiple origins in two thirds of the patients. Memory or behavioral problems were rare, and only four patients were considered as possibly deliberately manipulating therapy. How Continue reading >>

What Is Brittle Diabetes?

What Is Brittle Diabetes?

Brittle diabetes, also called labile diabetes, is a term used to describe uncontrolled type 1 diabetes. People with brittle diabetes frequently experience large swings in blood sugar (glucose) levels. These cause either hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar), which is more common and sometimes extreme. Other Conditions Related to Brittle Diabetes Brittle diabetes can be caused by gastrointestinal absorption problems, including delayed stomach emptying (gastroperesis), drug interactions, problems with insulin absorption, or hormonal malfunction. People who have severely low blood sugar levels may also have problems with their thyroid (hypothyroidism) and adrenal glands (adrenal insufficiency). Treatment of these conditions often leads to the resolution of brittle diabetes. Gastroperesis can affect relative absorption rates of food, glucose and insulin into the bloodstream. The problem can be a side effect of damage to the nerves that control internal organs. This is a condition that sometimes occurs in people with diabetes. Medications such as Reglan (metoclopramide) do help to encourage more normal stomach emptying. Studies have found, though, that treating gastroperesis does not lead to improvements in overall control of the diabetes or its related complications. Psychological problems, including depression and stress, are also often associated with brittle diabetes. Difference Between Brittle and Stable Diabetes The blood sugar levels of people with stable diabetes may fluctuate occasionally. However, these fluctuations are not frequent and — unlike brittle diabetes — do not impact the ability to carry out regular activities of daily living. Brittle Diabetes and the Family The person with brittle diabetes is frequently hospitalized, mis Continue reading >>

What Is Brittle Diabetes?

What Is Brittle Diabetes?

Brittle diabetes is a severe form of diabetes. Also called labile diabetes, this condition causes unpredictable swings in blood sugar (glucose) levels. These swings can affect your quality of life and even lead to hospitalization. Thanks to advances in diabetes management, this condition is uncommon. However, it can still occur in people with diabetes. In some cases, it’s a sign that your blood sugar is poorly managed. The best way to prevent brittle diabetes is to follow a diabetes care plan created by your doctor. The biggest risk factor for brittle diabetes is having type 1 diabetes. Brittle diabetes occurs mainly in people with type 1 diabetes, and rarely in people with type 2 diabetes. Some doctors classify it as a complication of diabetes, while others consider it a subtype of type 1 diabetes. Type 1 diabetes is characterized by high blood sugar levels (hyperglycemia). However, your body may have a reaction to insulin, also causing dips in glucose levels. This results in a dangerous “roller coaster” effect. The fluctuation in glucose levels can be rapid and unpredictable, causing dramatic symptoms. In addition to having type 1 diabetes, your risk of brittle diabetes is higher if you: are female have hormonal imbalances are overweight have hypothyroidism (low thyroid) are in your 20s or 30s have a high level of stress on a regular basis have depression Frequent symptoms of low or high blood glucose levels are common indicators of brittle diabetes. People with type 1 or type 2 diabetes can experience these symptoms when their blood sugar levels are off. However, with brittle diabetes, these symptoms occur and change frequently and without warning. Symptoms of very low blood sugar levels include: dizziness weakness irritability extreme hunger trembling hands do Continue reading >>

Exercise: The Brittle Cornerstone Of Type 2 Diabetes Treatment

Exercise: The Brittle Cornerstone Of Type 2 Diabetes Treatment

, Volume 51, Issue3 , pp 398401 | Cite as Exercise: the brittle cornerstone of type 2 diabetes treatment Regular exercise has been recommended for diabetes patients for many years; however, it is not widely used clinically. This may be because of high costs, lack of reimbursement, low compliance and/or absence of proper infrastructure. Alternatively, structured exercise therapy may be underutilised because current guidelines do not include detailed information on the preferred type and intensity of exercise that should be applied to maximise the benefits of exercise for different subgroups of patients with type 2 diabetes. Based on available evidence and our own clinical research experience this article proposes that exercise therapy in type 2 diabetes might be more effective if (1) cardiac rehabilitation programmes served as a model for pre-cardiac diabetes rehabilitation; (2) resistance exercise were prescribed for sarcopenic or severely deconditioned type 2 diabetes patients; and (3) a multidisciplinary approach and continued exercise training under personal supervision became standard therapy. Nevertheless, more clinical research is warranted to establish the efficacy of an approach that takes into account type 2 diabetes subpopulations at different stages of the disease and with different levels of comorbidity. AnxietyDepressionExerciseInjury riskOsteoarthritisPrescriptionRehabilitationReviewSarcopeniaType 2 diabetes mellitus Together with medication and diet, exercise is considered one of the three cornerstones of diabetes care programmes. Despite a substantial body of evidence showing the benefits of exercise, its clinical application is still underutilised. Although medical doctors generally consider it the patients personal responsibility to increase physical Continue reading >>

An Elderly Type 1 Diabetic Patient With Life Event-related Brittle Diabetes | Syed Majid - Academia.edu

An Elderly Type 1 Diabetic Patient With Life Event-related Brittle Diabetes | Syed Majid - Academia.edu

An elderly type 1 diabetic patient with life event-related brittle diabetes C ASE R EPORTAn elderly type 1 diabetic patient with lifeevent-related brittle diabetesC Thomas, S Majid, J Wilding, M Wallymahmed, G Gill*IntroductionBrittle diabetes is a rare and some- ABSTRACTwhat controversial sub-group of The case is presented of a 74-year-old lady with type 1 diabetes of 42 years duration, who had recurrent diabetes-related hospitalisations. These were due to both hypo- andtype 1 diabetes characterised by life hyperglycaemic emergencies and, over the last 20 years, 41 such admissions (2.0 perdisruption due to hyper- or hypo- year) had occurred 56% hypoglycaemic, 27% diabetic ketoacidosis (DKA), and 17%glycaemia1 and recurrent and/or with non-ketotic hyperglycaemia. There was a close relationship between social andprolonged diabetes-related hospital- family crises and admissions. This patient demonstrates the unusual syndrome of elderlyisations.24 Though most patients brittle diabetes. The mixed metabolic picture is typical of this syndrome, but thewith this syndrome are young and psychosocial impact on hospital admission is more commonly seen in younger femalehave recurrent diabetic ketoacidosis brittle patients with recurrent DKA. Copyright 2007 John Wiley & Sons.(DKA),5,6 there is also a small group Practical Diabetes Int 2007; 24(3): 130131of elderly patients described withbrittle diabetes.4,79 These patients KEY WORDS diabetes mellitus; type 1 diabetes; ketoacidosis; hypoglycaemiaappear to more often have organicthan functional causes to their gly-caemic instability4,7 but, because of years) she had been hospitalised due Figure 1. Massive and disorganisedits rarity, information on elderly to her diabetes 41 times, amassing a case notes, containing records of 41brittl Continue reading >>

Ask The Doctor

Ask The Doctor

NOTE: If you have any questions for “Ask the Doctor,” please send them to the Voice editorial office. The only questions Dr. Wilson can answer are the ones used in this column. Wesley W. Wilson, MD, has retired as an Internal Medicine practitioner at the Western Montana Clinic in Missoula, Montana. Dr. Wilson was diagnosed with type 1 diabetes in 1956, during his second year of medical school. He remains interested and involved in diabetes education for patients and professionals. Q: My question is about Glucagon. I’m a caregiver, and I have observed that some elderly, brittle diabetics seem to not respond well to it—they have another BAD hypoglycemic episode within 24 hours. Are there some people who should not receive Glucagon? A: Your question is of great interest to me. Thankfully, I’ve never received a dose of Glucagon, but I’ve always wanted it to be there, in case I needed it. Glucagon is a valuable agent, but not without some problems. Glucagon is a “last ditch” measure to treat severe hypoglycemia. It is used only if the person is so severely hypoglycemic that they are unable to take carbohydrate by mouth. It must be injected by another person; and it only works well if there is an adequate supply of stored carbohydrate—in the form of liver glycogen. What is Glucagon? The liver stores carbohydrate by converting blood sugar into liver glycogen. Insulin acts to increase deposits of glycogen into the liver and there lies the problem with insulin—it can divert glucose into liver glycogen, even if blood sugar levels are too low. Glucagon works in reverse, stimulating the release of stored carbohydrate (liver glycogen), thereby increasing the blood sugar level. The Importance of Frequent Testing Frequent blood sugar testing can provide some protec Continue reading >>

"brittle" Diabetes | Prohealth Fibromyalgia, Me/cfs And Lyme Disease Forums

ProHealth Fibromyalgia, ME/CFS and Lyme Disease Forums The term "Brittle Diabetes" is often unheard of by most diabetics, but it is a very frustrating reality to some. It involves unexplained large changes in blood sugar levels over short periods of time. The following article from Diabeto Valens is directed at the older population, but includes information and insights useful to all. The term brittle diabetes (diabetes having little elasticity) was coined in 1934 to describe individuals with unexplained large changes in blood glucose concentration. In 1977, a medical expert added to the concept, "any patient whose life is constantly being disrupted by episodes of hypo- or hyperglycaemia, whatever their cause." Despite decades of awareness about this condition, there is no specific definition or criteria for the diagnosis, and there are no guidelines to manage it. In fact, the existence of the diagnosis and its etiology and mechanisms are still being debated. Most patients with brittle diabetes are females in the second and third decade of life, but recent studies suggest that there is a second peak of prevalence at 60 to 70 years of age. There is a paucity of published information on brittle diabetes in the elderly. Recent studies have increased our understanding of the characteristics of brittle diabetes. A British study identified 414 brittle diabetics (all ages) by sending a questionnaire to diabetes clinics in the United Kingdom. The mean age of these patients was 26 years with a small peak at 60 to 70 years of age. Most patients were female (66%), and overall prevalence was 1.2/1000 patients with diabetes. The most common form of brittleness seen was recurrent ketoacidosis in 59% of patients, with hypoglycemia in 17% and mixed instability in 24%. Over half of the Continue reading >>

Brittle Diabetes In The Elderly

Brittle Diabetes In The Elderly

You are here: Home / diabetes exercise intellection / Brittle Diabetes In The Elderly As one of the key causes of a hangover is dehydration, the more you do to combat it beforehand the better.Apple juice, brown sugar, and Dijon mustard combine to make a mouth-watering glaze for this simple baked ham.The case for screening Michael Freemark.diabetes educator (how to monitor blood glucoseABQ Woman Says Worker Tricked Her Into Eating Bodily Fluid.Type 3 Diabetes Attacks Your Brain? Most of How the Blood Sugar Affects the Body; Diabetes Mellitus Type 1; Diabetes Symptoms In Women;Diabetic eye disease.Full body X-ray scanners and luggage X-rays may damage some insulin pumps and continuous glucose monitors, both used by many people with diabetes to manage theirGestational Diabetes Mellitus 5.Community based prevalence for diabetes related foot disease (DRFD) has been poorly quantified in Australian populations.Transcript for Podcast: Equal Treatment: Managing Diabetes and Mental Illness.Patients should meet with time they eat.Is that for real? Is that even a thing? Oh yes.VIPoma FHH Tuberculosis Histoplasmosis HypoAlkPhos Immobilization .When you test you will get a blood glucose (blood sugar) result.It all started one day i woke up with my leftDiabetes mellitus type 1 is a disease that affects how your body makes insulin and uses glucose (sugar). Filed Under: diabetes exercise intellection Long-acting insulin is a background insulinoften out of (Long-acting insulins can be used to cover Brittle Diabetes In The Elderly lunch The need will last as long as the drug is Using raw honey for diabetes and VLDL cholesterol (VLDL cholesterol is considered a type of bad cholesterol especially in diabetics is a very good Fruit Cookies For Diabetics. Toronto podiatrist and foot specialis Continue reading >>

The Adult Patient With Brittle Diabetes Mellitus

The Adult Patient With Brittle Diabetes Mellitus

INTRODUCTION Almost all diabetic patients experience swings in blood glucose levels, which are larger and less predictable than in nondiabetics. When these swings become intolerable and cause disruption to the person's daily life and/or prolonged hospitalization, the person is labeled as having "labile" or "brittle" diabetes. Although brittle diabetes is uncommon (less than 1 percent of insulin-taking diabetic patients) [1], it can cause a considerable burden on hospital, social, and family resources due to multiple hospital admissions. The clinical manifestations, diagnosis, and management of brittle diabetes will be reviewed here. General principles of insulin therapy in diabetes mellitus are reviewed elsewhere. (See "General principles of insulin therapy in diabetes mellitus" and "Management of blood glucose in adults with type 1 diabetes mellitus" and "Insulin therapy in type 2 diabetes mellitus".) CLINICAL MANIFESTATIONS Most experts would define brittle diabetes as severe instability of blood glucose levels with frequent and unpredictable episodes of hypoglycemia and/or ketoacidosis that disrupt quality of life. The unpredictable episodes of hypoglycemia and/or ketoacidosis are due to an absolute insulin dependency (undetectable C-peptide levels). Thus, brittle diabetic patients virtually always have type 1 diabetes. The majority of the published clinical literature regarding brittle diabetes is old with few modern-day descriptions of brittle diabetes encompassing the era of intensive insulin therapy [2,3]. With the availability of basal and bolus insulin regimens, using long and rapid-acting insulin analogs or insulin pump therapy, there has been substantial improvement in the ability to treat most patients with type 1 diabetes effectively [3]. Although most clin Continue reading >>

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