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Brittle Diabetes Uptodate

Honeymoon Phase

Honeymoon Phase

Tweet The Honeymoon Phase (or Honeymoon Period) amongst people with type 1 diabetes refers to the period of time shortly following diabetes diagnosis when the pancreas is still able to produce a significant enough amount of insulin to reduce insulin needs and aid blood glucose control. This does not, unfortunately, indicate that the diabetes is in remission or can be cured. How is the honeymoon period caused? Type 1 diabetes develops because the body begins to kill off its own insulin producing cells – know as islet cells. When a patient starts on insulin injections, the pancreas is under less pressure to produce insulin. This period of rest, afforded by the injections, stimulate the pancreas to produce insulin from the remaining beta cells. However, after a period of months, the vast majority of these remaining beta cells will also be destroyed, and the honeymoon period ends when the pancreas stops producing sufficient insulin to aid blood glucose control any more. What happens during the honeymoon phase? During the honeymoon phase, blood sugar levels are generally easier to control as the body still has some ability to help itself. Blood glucose levels may even return to normal levels during the honeymoon phase. Insulin doses may therefore need to be re-adjusted during this period and it is essential to communicate with your healthcare professional during this time. Can I stop taking insulin during the honeymoon period? A balance needs to be found between not taking too much insulin, and risking hypoglycemia, but also ensuring your body is not at risk of high blood glucose levels and the possibility of diabetic ketoacidosis. For this reason, you’ll need to discuss closely with your doctor the insulin doses you take. How long does the honeymoon period last? There i Continue reading >>

Brittle Diabetes Foundation (bdf) Provides Visibility To A Rare Disease

Brittle Diabetes Foundation (bdf) Provides Visibility To A Rare Disease

Brittle Diabetes Foundation (BDF) Provides Visibility to A Rare Disease EAST NORWICH, N.Y., Jan. 31, 2017 /PRNewswire/ -- BDF was established in 2012 by the Sorge family and their friends after nearly losing their 40 year-old daughter Rosemarie to Brittle Type 1 Diabetes (BT1D). Despite the diagnosis by attending physicians, US health agencies, at that time, did not recognize BT1D's existence. BDF's 2012 research into Brittle Diabetes, found 1,000+ medical research articles on BT1D and that the National Institutes of Health (NIH) had funded research for its cure. BDF requested an NIH review. On July 3, 2013 the NIH included BT1D in its list of rare diseases, set up an informational website, and listed BDF as the only organization supporting BT1D. BDF's mission is to raise awareness of the differences between stable type 1 diabetes and those diagnosed as being brittle, the primary characteristic of BT1D. Brittleness describes a rapid shifting in blood glucose levels, either up or down in a matter of minutes - the symptoms of which results in a disruption in daily life activities. Unlike stable T1D, BT1D defies all known therapies. It is unstable, uncontrollable and unpredictable. There is always a secondary cause for brittleness (18 identified to date) which when diagnosed and treated returns the patient to a more stable Type 1 condition. BDF looks to increase physician awareness of this disease by having them first determine their patient's level of glucose instability. If brittleness is diagnosed, the physician should determine its likely cause rather than labeling their patient non-compliant. At BDF's request, JDRF, a leader in T1D research, recognized the existence of brittle diabetes in 2016. On March 4, 2016, BDF submitted a proposal to the American Diabetes Assoc Continue reading >>

Brittle Diabetes Mellitus | Definition Of Brittle Diabetes Mellitus By Medical Dictionary

Brittle Diabetes Mellitus | Definition Of Brittle Diabetes Mellitus By Medical Dictionary

Brittle diabetes mellitus | definition of brittle diabetes mellitus by Medical dictionary Also found in: Dictionary , Thesaurus , Encyclopedia . Related to brittle diabetes mellitus: labile diabetes a general term referring to any of various disorders characterized by excessive urination (polyuria); when used alone, the term refers to diabetes mellitus . (See Atlas 4, Part D). brittle diabetes diabetes that is difficult to control, characterized by unexplained oscillation between hypoglycemia and diabetic ketoacidosis . (This term was formerly much used, but it is not a classification used by the World Health Organization or the American Diabetes Association.) central diabetes insipidus a metabolic disorder due to injury of the neurohypophyseal system, which results in a deficient quantity of antidiuretic hormone (ADH or vasopressin) being released or produced, resulting in failure of tubular reabsorption of water in the kidney. As a consequence, there is the passage of a large amount of urine having a low specific gravity, and great thirst; it is often attended by voracious appetite, loss of strength, and emaciation. Diabetes insipidus may be acquired through infection, neoplasm, trauma, or radiation injuries to the posterior lobe of the pituitary gland or it may be inherited or idiopathic. Treatment of pituitary diabetes insipidus consists of administration of vasopressin. A synthetic analogue of vasopressin (DDAVP) can be administered as a nasal spray, providing antidiuretic activity for 8 to 20 hours, and is currently the drug of choice. Patient care includes instruction in self-administration of the drug, its expected action, symptoms that indicate a need to adjust the dosage, and the importance of follow-up visits. Patients with this condition should wear some fo Continue reading >>

What Is Brittle Diabetes?

What Is Brittle Diabetes?

Brittle diabetes, also called labile diabetes, is a term used to describe hard-to-control type 1 diabetes. People with brittle diabetes frequently experience large swings in blood sugar (glucose) levels which can quickly move from too high (hyperglycemia) to too low (hypoglycemia) or vice versa. . Other Conditions Related to Brittle Diabetes Brittle diabetes can be caused by emotional distress (including depression and stress), eating disorders,gastrointestinal absorption problems, including delayed stomach emptying (gastroparesis), Celiac disease, 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 may lead to the resolution of 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 andunlike brittle diabetesdo not impact the ability to carry out regular activities of daily living. Brittle diabetes is relatively rare.According to the National Institute of Health (NIH),only a small proportion of people with type 1 diabetes experience the frequent blood glucose swings described as brittle.It affects approximately 3/1000 insulin-dependent people with diabetes, mainly young women,with overweight women more likely to be affected. Most people with brittle diabetes tend to be between the ages of 15 and 30. Additionally, people with psychological problems, such as stress and depression, are at highest risk of experiencing brittle diabetes. In some cases, these psychological problems lead them to neglect self-care for their diabetes. For e Continue reading >>

What Is Brittle Diabetes?

What Is Brittle Diabetes?

Brittle diabetes is the name doctors give diabetes that is especially hard to control. It’s also called “labile” diabetes. The words brittle and labile can both mean “unstable” or “easily changed.” When you have brittle diabetes, your blood glucose levels often swing from very low (hypoglycemic) to very high (hyperglycemic). It's almost always associated with type 1 diabetes. It isn’t a separate kind of diabetes, but more like a complication, or subset of the disease. Because any diabetes can be unstable when you don’t manage it well, a brittle diabetes diagnosis can be tricky. If your blood sugar levels swing wildly, there could be many reasons for it, including: You’re not taking your medication or testing your glucose levels like you should. Your intestines struggle to absorb nutrients. Gastroparesis -- a condition that slows down or stops the emptying of food from your stomach into your intestines You're very sensitive to insulin Often, it can be one or more of these. In many cases, doctors don’t know exactly what causes it. Depending on which way your blood glucose level in swinging, your symptoms can be different. They're "very low" at below 70 mg/dl. Symptoms can include: Feeling shaky Irritability Confusion Weakness Unconsciousness When your blood sugar shoots up above 200 mg/dl, your symptoms will likely include: If you don’t treat high blood sugar, it can turn into a more serious condition called ketoacidosis. That's when toxins called ketones build up in your blood and urine. It can cause: Breath that smells fruity Shortness of breath Weakness Confusion Brittle diabetes isn't common. About 3 out of every 1,000 people who take insulin for diabetes will get it. People of all ages can have brittle diabetes. Women get it a bit more often t Continue reading >>

What Is The Honeymoon Period In Type 1 Diabetes?

What Is The Honeymoon Period In Type 1 Diabetes?

Does everyone experience this? The “honeymoon period” is a phase that some people with type 1 diabetes experience shortly after being diagnosed. During this time, your diabetes may seem to go away. You may only need minimal amounts of insulin. Some people even experience normal or near-normal blood sugar levels without taking insulin. This happens because your pancreas is still making enough insulin to help control your blood sugar. Not everyone with diabetes has a honeymoon period, and having one doesn’t mean your diabetes is cured. There isn’t a cure for diabetes, and a honeymoon period is only temporary. Everyone’s honeymoon period is different, and there isn’t a set time frame for when it begins and ends. Most people notice its effects shortly after being diagnosed. The phase can last weeks, months, or even years in some cases. The honeymoon period only happens after you first receive a diagnosis of type 1 diabetes. Your insulin needs may change throughout your life, but you won’t have another honeymoon period. This is because with type 1 diabetes, your immune system destroys insulin-producing cells in your pancreas. During the honeymoon phase, the remaining cells keep producing insulin. Once those cells die, your pancreas can’t start making enough insulin again. During the honeymoon period, you may achieve normal or near-normal blood sugar levels by taking only minimal amounts of insulin. You may even be in the normal range without taking any insulin. The target blood sugar ranges for adults with diabetes are: A1C: 7 percent A1C when reported as eAG: 154 milligrams/deciliter (mg/dL) preprandial plasma glucose, or before starting a meal: 80 to 130 mg/dL postprandial plasma glucose, or one to two hours after beginning a meal: Less than 180 mg/dL Your 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 >>

Type 1 Diabetes Linked To Lower Life Expectancy In Study

Type 1 Diabetes Linked To Lower Life Expectancy In Study

But, second study suggests that intensive blood sugar management can make a difference Please note: This article was published more than one year ago. The facts and conclusions presented may have since changed and may no longer be accurate. And "More information" links may no longer work. Questions about personal health should always be referred to a physician or other health care professional. HealthDay Reporter TUESDAY, Jan. 6, 2015 (HealthDay News) -- People with type 1 diabetes today lose more than a decade of life to the chronic disease, despite improved treatment of both diabetes and its complications, a new Scottish study reports. Men with type 1 diabetes lose about 11 years of life expectancy compared to men without the disease. And, women with type 1 diabetes have their lives cut short by about 13 years, according to a report published in the Jan. 6 issue of the Journal of the American Medical Association. The findings "provide a more up-to-date quantification of how much type 1 diabetes cuts your life span now, in our contemporary era," said senior author Dr. Helen Colhoun, a clinical professor in the diabetes epidemiology unit of the University of Dundee School of Medicine in Scotland. Diabetes' impact on heart health appeared to be the largest single cause of lost years, according to the study. But, the researchers also found that type 1 diabetics younger than 50 are dying in large numbers from conditions caused by issues in management of the disease -- diabetic coma caused by critically low blood sugar, and ketoacidosis caused by a lack of insulin in the body. "These conditions really reflect the day-to-day challenge that people with type 1 diabetes continue to face, how to get the right amount of insulin delivered at the right time to deal with your blood Continue reading >>

Brittle Diabetes? - Tudiabetes Forum

Brittle Diabetes? - Tudiabetes Forum

In my job I kinda have to tell the people of my diabetes as i will be cleaning there places usually when they are gone. While meeting with my newest client today, i told her i have diabetes and we went through all the usual questions of what type I am and meds i take ect. and when she got all the info, she said, oh I get it your a brittle diabetic. What is that? I didnt have time to ask her anything else as I was late for work. Brittle diabetes is what I have. When sugars are really hard to control, going form high to low but without a pattern and nothing much in between! She may or may not be right - she is possibly presuming that because of you talking about highs and lows, and is just presuming that. If you are unsure you may have to ask your doctor and then put her straight. At least from the little you have said she sounds accepting. I have been thrown out of various courses and ministries in the church in case you get ill! A lot of people in the general public dont realize that daily highs and lows are just part of life with diabetes. Ive talked to people who think in control means my blood sugar is in range all the time I wish!!! Also, Ive read that only 1% of Type 1s are truly brittle in the sense that they land in the hospital regularly due to extreme highs or lows, and that the term is vastly overused. A lot of times it just means someone is on the wrong insulin regimen and its not matched to their bodys insulin needs. A nurse (friend of a friend) said I was brittle knowing nothing about me. I test frequently therefore I must be brittle because only brittle diabetics need to do this. Huh? Curious why you feel you needed to tell her when no one is there while you work. Im with Jennifer that the term is over-used & also outdated. This is my absolute least favor Continue reading >>

Brittle Diabetes

Brittle Diabetes

Brittle diabetes is a term that is sometimes used to describe hard-to-control diabetes (also called labile diabetes). It is characterized by wide variations or “swings” in blood glucose (sugar) in which blood glucose levels can quickly move from too high (hyperglycemia) to too low (hypoglycemia). These episodes are hard to predict and can disrupt quality of life. They can require frequent or lengthy hospitalizations and can be fatal. People with type 1 diabetes are at greatest risk. While many people with type 1 diabetes experience hypoglycemia, only a small proportion of people with type 1 diabetes experience the frequent blood glucose swings described as “brittle.” People with long-standing type 2 diabetes may also have difficulty controlling blood glucose, but few have these frequent swings. People of any age with diabetes can be affected with these frequent ups and downs in blood glucose levels. Some research suggests that women may be affected more often than men. Frequent episodes of hypoglycemia can lead to hypoglycemic unawareness and make the condition worse. Keeping diabetes under good control for at least several weeks can restore hypoglycemic awareness. New technologies such as continuous glucose monitors and insulin pumps may help improve control.In diabetes, many factors can trigger frequent changes in blood glucose levels. For example, people who don’t test blood glucose or take diabetes medications as prescribed often experience significant fluctuations in blood glucose levels. Other causes of unstable blood glucose levels include emotional stress, eating disorders, drug or alcohol use, malabsorption, gastroparesis, and celiac disease. The development of new treatments for diabetes has made it easier for most people to control their blood gluco Continue reading >>

Bone And Joint Problems Associated With Diabetes

Bone And Joint Problems Associated With Diabetes

If you have diabetes, you're at increased risk of various bone and joint disorders. Certain factors, such as nerve damage (diabetic neuropathy), arterial disease and obesity, may contribute to these problems — but often the cause isn't clear. Learn more about various bone and joint disorders, including symptoms and treatment options. Charcot joint What is it? Charcot (shahr-KOH) joint, also called neuropathic arthropathy, occurs when a joint deteriorates because of nerve damage — a common complication of diabetes. Charcot joint primarily affects the feet. What are the symptoms? You might have numbness and tingling or loss of sensation in the affected joints. They may become warm, red and swollen and become unstable or deformed. The involved joint may not be very painful despite its appearance. How is it treated? If detected early, progression of the disease can be slowed. Limiting weight-bearing activities and use of orthotic supports to the affected joint and surrounding structures can help. Diabetic hand syndrome What is it? Diabetic hand syndrome, also called diabetic cheiroarthropathy, is a disorder in which the skin on the hands becomes waxy and thickened. Eventually finger movement is limited. What causes diabetic hand syndrome isn't known. It's most common in people who've had diabetes for a long time. What are the symptoms? You may be unable to fully extend your fingers or press your palms together flat. How is it treated? Better management of blood glucose levels and physical therapy can slow the progress of this condition, but the limited mobility may not be reversible. Osteoporosis What is it? Osteoporosis is a disorder that causes bones to become weak and prone to fracture. People who have type 1 diabetes have an increased risk of osteoporosis. What are Continue reading >>

Diabetes In The Classroom: Time To Be Prepared

Diabetes In The Classroom: Time To Be Prepared

Diabetes in the Classroom: Time to be Prepared Classroom teachers have responsibilities far more broad than just teaching the subject. Presiding as the only authority figure in the classroom for hours each day, the teacher is responsible for the welfare of students. Theres no buckpassing; the teacher is in the room, and the school nurse is not. So what happens when a student has diabetes? Hopefully the teacher has been informed. When a student is diagnosed, or when a diabetic child enrolls in school, it is the parents or guardians responsibility to let school authorities know of the conditionand what needs to be done to help keep the child from running blood sugars too low or too high. The desire to conform, to not stand out, may be powerful; but if a child has type 1 diabetes, or severe type 2, it can be a life and death matterParents must let the school authorities know! If your child has type 1 diabetes (or brittle enough type 2 that emergencies can occur) it may be grounds for preparation of an IEP (Individualized Education Program) or a 504 Plan (in other states that do not use the IEP). Such an individual plan is ideally worked out among parents, school administrators, and pertinent medical professionals (such as the childs primary care physician and diabetes educator). Sometimes the schools counselor will be involved. The plan they prepare should spell out the teachers role in the childs day-to-day diabetes self-management, and that of other school personnel. Parentsyou need to be part of the process here. There are privacy considerations, described in HIPAA, the Health Insurance Privacy and Portability Act. Appropriate documents must be signed and filed before school administrators and health care professionals can legally discuss a childs condition with anyone Continue reading >>

Sliding Scale: Sliding Scale Uptodate

Sliding Scale: Sliding Scale Uptodate

Insulin Aspart - Wikipedia, The Free Encyclopedia Insulin aspart is a fast-acting insulin analog marketed by Novo Nordisk as NovoLog/NovoRapid. It is a man-made form of human insulin; where a single amino acid has been exchanged. This change helps the fast-acting insulin analog be absorbed quickly into the bloodstream. ... Read Article The Uses Of Heparin In Stroke And Other Diseases Heparin: Drug information. In: UpToDate, Rose, BD (Ed), UpToDate, Waltham, MA, 2008. Related Articles. What Drugs Can Help Prevent or Treat Blood Clots? Do Blood Thinners Such as Coumadin and Plavix have Side Effects? How Does the Blood Clot? ... Read Article Alcohol Withdrawal Protocol - Division On Addiction Alcohol Withdrawal Protocol Give Thiamine 100mg IV initially and qd (po, IM/IV), Folate 1mg qd, MVI qd. institute withdrawal assessment for alcohol scale (CIWA-Ar). Br J Addict 1989;84:1353-7. Turner RC, Lichstein PR, Peden JG Jr, Busher JT, Waivers LE. ... Retrieve Document Rating scales For Depression - Wikipedia, The Free Encyclopedia A depression rating scale is a psychiatric measuring instrument having descriptive words and phrases that indicate the severity of depression for a time period. When used, an observer may make judgements and rate a person at a specified scale level with respect to identified characteristics ... Read Article New Guidelines For Potassium Replacement In Clinical Practice New Guidelines for Potassium Replacement in Clinical Practice A Contemporary Review by the National Council on Potassium in Clinical Practice Jay N. Cohn, MD; The large-scale Nurses Health Study (N=41541) found that dietary potassium intake was inversely associated with blood pressure. ... View This Document Adult ACS-MI Heparin Protocol (Effective June 2011 - Present) Adult ACS-MI Hepa Continue reading >>

Is Brittle Diabetes Real?

Is Brittle Diabetes Real?

You will have to decide the answer to this question yourself. In my opinion, the bigger question is, Is brittle diabetes an excuse for both people with diabetes and healthcare providers who are not able to control diabetes? The dictionary definition of the word brittle is easily broken. The diabetes literature uses the word labile when examining brittle diabetes. The dictionary definition of the word labile is changeable. If we use these words to describe diabetes, then maybe the answer is yes, brittle diabetes is real, but then again The diabetes literature discusses brittle or labile diabetes as blood glucose swings that disrupt quality of life due to unpredictable hypo and hyperglycemia, DKA, frequent hospitalizations, and missed days at work and other activities.1 Lets consider the word unpredictable. I think all of who live with type 1 diabetes often experience predictable swings in blood glucose! But do you regularly have blood glucose swings that you have no idea why you are high or low? The literature does suggest that people with diabetes who experience gastroperesis have unpredictable blood glucose swings, especially when they dont know what effect the foods they are eating will have on the condition.2 Another reason for unpredictable swings in blood glucose is depression and/or stress that may cause people to neglect caring for their diabetes. Some of the literature shows that hormonal changes in people who are depressed or stressed may actually raise blood glucose, but that behavior therapy and medication can make diabetes management easier for these individuals.3 Its interesting to note that, since the era of intensive insulin therapy, there are fewer published articles on brittle diabetes.4,5 What this means to me is that because we now have the tools and Continue reading >>

The Bitterness Over 'brittle Diabetes'

The Bitterness Over 'brittle Diabetes'

Written by Wil Dubois on February 21, 2017 With the 10th annual Rare Disease Day just around the corner on Feb. 28, it's a perfect time to revisit the issue of "brittle diabetes" and how recognition of it as a rare disease (or lack thereof) has sparked a new wave of controversy recently. Those watching the news wire may have caught some of the press releases, like the one in January screaming that the " American Diabetes Association Ignores Those Suffering with Brittle Diabetes " and another on Feb. 14 accusing the ADA of taking an " ostrich approach " to brittle diabetes. The organization behind those announcements is the New York-based Brittle Diabetes Foundation (BDF), which has been lobbying everyone in sight to accept a new classification of "BT1D" (Brittle T1D), for those of us with extreme blood sugar instability. While this Foundation has successfully lobbied the National Institutes of Health (NIH) to include brittle diabetes as a rare disease in its national database, and other orgs like the JDRF and American Diabetes Association have at least acknowledged it to some extent, the BDF does not believe the ADA has gone far enough -- and is spending a lot of energy on calling out the country's largest diabetes organization over it. Specifically, the BDF (not to be confused with your Best Diabetes Friend) is blasting the ADA for not including brittle diabetes in its 2017 Standards of Care , an omission the BDF describes as disgraceful and sad," and they claim it ignores some 4,500 US residents and 150,000 worldwide diagnosed with BT1D. When this foundation was formed back in 2013, DiabetesMine reported on its origins -- along with the new NIH designation -- and found in large part that medical professionals viewed "brittle" as an outdated term that should no longer Continue reading >>

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