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What Does Brittle Diabetic Mean

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 >>

Diabetic Alert Dogs: What Do Their Noses Know?

Diabetic Alert Dogs: What Do Their Noses Know?

Diabetic Alert Dogs: What Do Their Noses Know? Diabetic alert dogs (DADs) have become more mainstream over the past several years. Trained to alert to low, and sometimes high, blood sugar levels, DADs are usually placed with persons with type 1 diabetes. There are, however, potential DAD applications in the management of type 2 diabetes (T2DM). Consultantlive.com talked with Lily Grace, a registered nurse and founder of the National Institute for Diabetic Alert Dogs (NIDAD), a Nevada corporation that has trained more than 400 DADs over the past 11 years. The Nose Knows With more than 220 million scent receptors, a dogs nose is more than 1000 times more sensitive than a humans.1 DADs pick up on volatile organic compounds (VOCs), excreted in urine, sweat, saliva, and pulmonary vapors. Science has yet to explain exactly what compounds the dogs are able to smell, but likely candidates include ketosis products. Changes in body chemistry can appear in body secretions 15 to 30 minutes before showing up in the blood. Oftentimes, values from continuous glucose meters (CGMs) or home blood glucose meters lag behind what a well-trained DAD can sense; a retest is required about 10 to 15 minutes after an alert from the dog. The pre-warning, according to Grace, helps improve glycemic control by putting patients on alert that there is a change happeningblood sugar trending up or downso that they can take appropriate action; the improved control, she notes has helped achieve reductions in HbA1c as great as 1%. It doesnt mean you dont treat without testing, Grace explained. The dog is typically faster than a CGM, but CGMs give a number and the dog does not. Its still a dog, and dogs will occasionally miss a low. So its always a combination of tools. It is absolutely critical that people Continue reading >>

What To Do About Brittle Diabetes

What To Do About Brittle Diabetes

Q: I am a brittle diabetic and live in fear every day as my blood sugar goes from high to very low within a few hours, and I never know it’s low until it is too late. I understand there’s a new oral drug for this, and I hope you can share some information with me. Also, I’d like to know what’s new in terms of a cure-I hear rumors, but never see the new techniques or good news in doctor’s offices. Please share any news of new treatment. A. M. Craft Ashland, KY A: You have really asked three good questions, and I will address them separately. 1. You are very correct to be concerned about the very low blood sugars, especially if you can’t sense it until it is “too late.” It is very important that you review this with your doctor, and a change in insulin regimen be made. “Hypoglycemia unawareness” is not rare, and is generally treated by allowing the blood sugars to rise high enough that the low blood sugars are eliminated. One then seeks to attain a more stable or predictable level of control of higher blood sugars, and then slowly bring them down. Causes of unexplained hypoglycemia include life-style problems (unexpected stresses, erratic food habits, etc.), gastroparesis (slow and unpredictable emptying of food from the stomach), erratic insulin absorption from injection sites (especially if there is a buildup or breakdown of fat below the skin), and other factors. All of these should be reviewed with your doctor. For erratic life-style issues, a more structured program is helpful. For gastroparesis, medications such as Reglan, Motilin, or Cisapride may be effective, as may having some liquid portion at each meal. Remember that fat tends to be released from the stomach more slowly in all people. For areas of abnormal fat buildup or breakdown under the Continue reading >>

Type 1 Diabetes

Type 1 Diabetes

Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention Definition Diabetes is a higher level of glucose in the blood than is normal. Glucose travels through the body in the blood. A hormone called insulin then helps glucose move from the blood to the cells. Once glucose is in the cells it can be used for energy. A problem making or using insulin means glucose cannot move into cells. Insulin also helps glucose to move into the liver for storage if there is too much to use. Without enough insulin, glucose will build up in the blood. In type 1 diabetes, the body does not make insulin. This will lead to the build up of glucose in the blood, also called hyperglycemia. At the same time, cells are not getting glucose they need to function well. Over a long period of time high blood glucose levels can also damage vital organs. The blood vessels, heart, kidneys, eyes, and nerves are most commonly affected organs. Type 1 diabetes is often found during childhood and young adulthood. Causes Our immune system keeps us well by fighting off and destroying viruses and bacteria. Unfortunately, sometimes the immune system attacks healthy tissue. Most type 1 diabetes develop because the immune system attacks and destroys the cells that make insulin. These cells are in the pancreas. It is not yet clear why the immune system attacks these cells. It is believed that some people have genes that make them prone to getting diabetes. For these people, certain triggers in the environment may make the immune system attack the pancreas. The triggers are not known but may be certain viruses, foods, or chemicals. Type 1 diabetes may also develop as a complication of other medical conditions. It may develop in: People with chronic type 2 diabetes who lose the ability to mak Continue reading >>

Diabetes Symptoms You Can’t Afford To Ignore & What You Can Do About Them

Diabetes Symptoms You Can’t Afford To Ignore & What You Can Do About Them

In the U.S., diabetes — or diabetes mellitus (DM) — is full-blown epidemic, and that’s not hyperbole. An estimated 29 million Americans have some form of diabetes, nearly 10 percent of the population, and even more alarming, the average American has a one in three chance of developing diabetes symptoms at some point in his or her lifetime. (1) The statistics are alarming, and they get even worse. Another 86 million people have prediabetes, with up to 30 percent of them developing type 2 diabetes within five years. And perhaps the most concerning, about a third of people who have diabetes — approximately 8 million adults — are believed to be undiagnosed and unaware. That’s why it’s so vital to understand and recognize diabetes symptoms. And there’s actually good news. While there’s technically no known “cure” for diabetes — whether it’s type 1, type 2 or gestational diabetes — there’s plenty that can be done to help reverse diabetes naturally, control diabetes symptoms and prevent diabetes complications. The Most Common Diabetes Symptoms Diabetes mellitus is a metabolic disorder that results from problems controlling the hormone insulin. Diabetes symptoms are a result of higher-than-normal levels of glucose (sugar) in your blood. With type 1 diabetes, symptoms usually develop sooner and at a younger age than with type 2 diabetes. Type 1 diabetes also normally causes more severe symptoms. In fact, because type 2 diabetes signs and symptoms can be minimal in some cases, it sometimes can go diagnosed for a long period of time, causing the problem to worsen and long-term damage to develop. While it’s still not entirely known how this happens, prolonged exposure to high blood sugar can damage nerve fibers that affect the blood vessels, heart, e Continue reading >>

"brittle" Diabetes

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 problem becomes separating the truly "brittle" diabetics from the non-compliant, the poorly-controlled, or those whose unstable sugars have other explanations. Some have insisted that if all diabetics diligently practiced "tight control" (as described by the DCCT), none would be "brittle." They're partially right; the numbers would go down, but some diabetics can do everything right and still remain "brittle." These are the diabetics, even practicing tight control, whose blood glucose level "over-reacts" to minute changes in diet, exercise, and/or insulin. These individuals experience unpredictable rises and swoops in blood glucose, within very short periods, as the result of very small departures from schedule. Small changes "break" their control, and they are thus said to be "brittle." If you are practicing tight control, are in good compliance with your schedule, and are still experiencing rapid, out-of-proportion blood glucose changes, talk to your doctor. You (or more correctly your diabetes) may be "brittle," but your instabilities may well be a sign of some other pro Continue reading >>

10 Surprising Causes Of Blood Sugar Swings You Probably Didn’t Know

10 Surprising Causes Of Blood Sugar Swings You Probably Didn’t Know

1 / 11 What Causes Blood Sugar to Rise and Fall? Whether you were recently diagnosed with type 2 diabetes or have been living with the disease for several years, you know how fickle blood sugar levels can be, and how important it is that they stay controlled. Proper blood sugar control is key for helping ward off potential diabetes complications, such as kidney disease, nerve damage, vision problems, stroke, and heart disease, according to the National Institutes of Health (NIH). If you keep your levels in check on a daily basis, it will help you stay energized, focused, and in a good mood. You’ll know if your diabetes is poorly controlled if you experience symptoms such as frequent urination, sores that won’t heal, blurred vision, and unexplained weight loss. According to the American Diabetes Association (ADA), proper medication, effective meal planning, regular exercise, and use of a blood glucose meter to track your numbers routinely can all help you keep your levels within a healthy range. The ADA recommends blood glucose be 80 to 130 milligrams per deciliter (mg/dL) before meals, and below 180 mg/dL two hours after the start of a meal. Furthermore, the organization recommends getting an A1C test, which measures your average blood glucose over the past two to three months, at least twice per year if your levels are stable and you are meeting treatment goals. Learning how different habits can cause your blood sugar to fluctuate can help you better predict how your levels will swing. You may be more likely to experience hypoglycemia, or low blood sugar if you have advanced-stage diabetes, according to the ADA. Meanwhile, high blood sugar, or hyperglycemia, may be caused by factors such as not using enough insulin or other diabetes medication, not following a prop Continue reading >>

What Is Brittle Diabetes?

What Is Brittle Diabetes?

Friend Diagnosed with type two on July 5th, 2006 I don't quite understand it! I googled the word but it just kept coming up and talking about changes in sleep patterns and brittle meaning that changes happen in diabetics that they cannot control...off and on...SO, how does a person know or realize that they have these issues..and or are a brittle diabetic? D.D. Family T1 since 1977 - using Novolog in an Animas pump. When T1 is hard to control, it is often refered to as "brittle diabetes". A lot of people don't believe that such a thing actually exists. Blood glucose fluctuates because the insulin needs are not being properly matched with insulin(see this article ). It doesn't really apply to T2. Friend T1 since 2000, on pump, good for info!!! mm... brittle diabetes used to be another name for type 1... When life gives you lemons, throw them at someone!!! What Mark said. It's an old school term like adult-onset D Insulin (avg): 19.8 U (35% bolus); CHO (avg): 87g; BG (avg): 97 mg/dl; SD: 31 Tests (avg): 5.1; High: 168; Low: 51; highs>140: 3; lows<70: 10 The ADA Complete Guide to Diabetes, 4th edition describes "brittle diabetes" as follows: You used to hear the term "brittle diabetes" often before glucose monitoring became possible for everyone. Now, it's rarer for people with diabetes to be unaware of these swings and frustrated about why they can't manage their blood glucose levels. It goes on to say that glucose monitoring for most people has made brittle diabetes extinct. It further states that a regular program of monitoring yields plenty of clues about why your blood glucose levels go up and down. Further stating that exteme swings in glucose levels are primarily a problem for people who inject insulin, not just one type1 or type2. brittle diabetic means insulin re Continue reading >>

What Does

What Does "brittle" Really Mean?

Estimating foods, response curves, when to eat - when to refrain from eating. Testing and lots more testing. It's a disease with lots of tiny management moments. A few years after I was first diagnosed, I met someone on the pump who told me he was on the pump because he was a "brittle diabetic." I asked him to explain what that meant and still do not know. What does it mean to be a brittle diabetic? I personally thought, as a Type I - you HAD it - or you didn't. (Or else you were a Type 2.) The whole control thing - pain in the rear as it is - I thought was a constant. It's constantly hard and needs constant attention. I kind of felt like I was an inferior diabetic - the real men were brittle. Is there such a thing - really? Or is this a term that people use to describe diabetics struggling to get control? Friend T1 since 1975, MDI, proliferative retinopathy. It does refer to those diabetics who have extreme difficulty gaining control. Those who go high or low for no apparent reason. I considered myself one before pumping. It was a very frustrating time. Since my endo talked me into pumping, I've learned very much about insulin management. In fact, I now feel I have close to total control over my disease. I'm empowered, hence my handle. But it's still not easy. Why isn't it easy? I've discovered I have very wavy basal patterns. I drop to 0.7u in the night, I jump up to 1.85u in the mornings, I plummet back down to 0.45u during the day, and I peak around 1.35u in the evening. I have roller coaster basals. I've learned that not everyone is like me. I found a reference somewhere I can't find again saying about 35% of us have roller coaster basals. The rest are flatliners. Flatliners have small variations in basal rates and I:C ratios. They seem to be able to get their A1C Continue reading >>

New Methods In Exploring Old Topics: Case Studying Brittle Diabetes In The Family Context

New Methods In Exploring Old Topics: Case Studying Brittle Diabetes In The Family Context

New Methods in Exploring Old Topics: Case Studying Brittle Diabetes in the Family Context 1Psychoanalytic Family Therapy, Center of Child and Adolescent Medicine, Justus-Liebig-University, Feulgenstrae 10-12, 35392 Giessen, Germany 2Department of Economics, Justus-Liebig-University Giessen, Licher Strae 64, 35394 Giessen, Germany 3Pediatric Endocrinology & Diabetology, Center of Child and Adolescent Medicine, Justus-Liebig-University, Feulgenstrae 10-12, 35392 Giessen, Germany Received 31 October 2014; Accepted 7 March 2015 Copyright 2016 Moritz Philipp Gnther et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. In questing for a more refined quantitative research approach, we revisited vector autoregressive (VAR) modeling for the analysis of time series data in the context of the so far poorly explored concept of family dynamics surrounding instable diabetes type 1 (or brittle diabetes). Method. We adopted a new approach to VAR analysis from econometrics referred to as the optimized multivariate lag selection process and applied it to a set of raw data previously analyzed through standard approaches. Results. We illustrated recurring psychosomatic circles of cause and effect relationships between emotional and somatic parameters surrounding glycemic control of the childs diabetes and the affective states of all family members. Conclusion. The optimized multivariate lag selection process allowed for more specific, dynamic, and statistically reliable results (increasing R2 tenfold in explaining glycemic variability), which were derived from a larger window of past explanatory variables (lags Continue reading >>

Management Strategies For Brittle Diabetes.

Management Strategies For Brittle Diabetes.

Abstract Type 1 diabetes is an intrinsically unstable condition. However, the term "brittle diabetes" is reserved for those cases in which the instability, whatever its cause, results in disruption of life and often recurrent and/or prolonged hospitalization. It affects 3/1000 insulin-dependent diabetic patients, mainly young women. Its prognosis is poor with lower quality of life scores, more microvascular and pregnancy complications and shortened life expectancy. Three forms have been described: recurrent diabetic ketoacidosis, predominant hypoglycemic forms and mixed instability. Main causes of brittleness include malabsorption, certain drugs (alcohol, antipsychotics), defective insulin absorption or degradation, defect of hyperglycemic hormones especially glucocorticoid and glucagon, and above all delayed gastric emptying as a result of autonomic neuropathy. Psychosocial factors are very important and factitious brittleness may lead to a self-perpetuating condition. The assessment of brittle diabetes requires quantification of the variability of blood glucose levels. To quantify instability, measures which have been developed, include Mean Amplitude of the largest Glycemic Excursions (MAGE), Mean Of Daily Differences (MODD), Lability Index (LI), Low Blood Glucose Index (LBGI), Clarke's score, Hyposcore, and continuous blood glucose monitoring. Once psychogenic problems have been excluded, therapeutic strategies require firstly, the treatment of underlying organic causes of the brittleness whenever possible and secondly optimising standard insulin therapy using analogues, multiple injections and consideration of Continuous Subcutaneous Insulin Infusion. Alternative approaches may still be needed for the most severely affected patients. Isolated islet transplantation Continue reading >>

Type 5 Diabetes?

Type 5 Diabetes?

Researchers suggest there should be five diagnostic groups for diabetes, not just two. We often say that no two cases of Type 1 diabetes behave in the same way, and that each presents its own set of challenges. Diabetes presents itself differently depending on whether one was diagnosed in childhood or adulthood, and having both insulin resistance and Type 1 diabetes is more difficult to manage than just Type 1 diabetes alone. And then there are the diagnostic grey areas, including Latent Autoimmune Diabetes (LADA), Maturity Onset Diabetes of the Young (MODY), and what is sometimes characterized as brittle diabetes, all of which are difficult to diagnose properly. Swedish researchers now suggest that there should be five distinct diagnostic subgroups of diabetes, instead of the binary division between Type 1 diabetes and Type 2 diabetes. According to a report in Endocrinology Advisor, researchers at the Lund University Diabetes Centre made this recommendation after analyzing genetic and non-genetic markers for more than 15,000 patients with diabetes in Finland and Sweden. They then used five diagnostic yardsticks (age of onset, body mass index, A1C score, level of insulin secretion and how the insulin interacts in the bloodstream) to accurately predict changes in A1C scores over time in both people with Type 1 diabetes and people with Type 2 diabetes. From these experiments, the researchers now believe these should be the five different groups of people with diabetes: Those with what would be categorized as “typical” Type 1 diabetes from autoimmune reactions Those who have beta cell impairment caused by something other than autoimmune reaction Those who have the most insulin-resistance and highest risk of kidney disease Those who are the most obese Those with diabete Continue reading >>

Pancreatogenic (type 3c) Diabetes

Pancreatogenic (type 3c) Diabetes

1. Definition Pancreatogenic diabetes is a form of secondary diabetes, specifically that associated with disease of the exocrine pancreas. The most common disease of the exocrine pancreas associated with the development of diabetes is chronic pancreatitis. Analogous to chronic pancreatitis-associated diabetes is cystic fibrosis-related diabetes (CFRD), in which pancreatic exocrine insufficiency pre-dates the pancreatic endocrine insufficiency responsible for the development of diabetes. Because diabetes in cystic fibrosis is associated with worse nutritional status, more severe inflammatory lung disease, and greater mortality from respiratory failure, CFRD has long been recognized as a distinct form of diabetes requiring a specified approach to evaluation and treatment (30) now recognized by the American Diabetes Association (28). While the distinct pathogenesis of diabetes in chronic pancreatitis has also long been appreciated, only recently have guidelines been developed supporting a specified diagnostic and therapeutic algorithm (37). Finally, other less common forms of pancreatogenic diabetes exist, such as that due to pancreatic cancer (18), as well as post-pancreatectomy diabetes, with each requiring individualized approaches to care. 2. Classification Pancreatogenic diabetes is classified by the American Diabetes Association and by the World Health Organization as type 3c diabetes mellitus (T3cDM) and refers to diabetes due to impairment in pancreatic endocrine function related to pancreatic exocrine damage due to acute, relapsing and chronic pancreatitis (of any etiology), cystic fibrosis, hemochromatosis, pancreatic cancer, and pancreatectomy, and as well rare causes such as neonatal diabetes due to pancreatic agenesis (1). Prevalence data on T3cDM are scarce b Continue reading >>

8 Things I Wish People Understood About Having Type 1 Diabetes

8 Things I Wish People Understood About Having Type 1 Diabetes

I was 25 and in the middle of my second year of law school when I started feeling tired, thirsty, and hungry. I had blurry vision all the time. I was lucky — I mentioned this to a friend, and she said whenever she complained about her eyes her dad tested her blood sugar, because that's how he got diagnosed with diabetes. I had a family history of both types, but I figured I was too old for Type 1 and too young and too much of a gym rat for Type 2. Still, I went to student health. I explained my typical diabetes symptoms and family history to a person we will call "Helpful Nurse." Helpful Nurse decided the best immediate course of action would be to gaslight me aggressively in the five minutes it took to get the results back on my sugar test. "We don't usually get people in here 'thinking' they have 'diabetes.'" Cool story. "See, your vision isn't that bad." It's usually 20/19. "I'm sure you're just stressed about finals." Yeah, especially since I've spent most of the semester unconscious. That's when we heard someone scream from the lab down the hall and around a corner, "Don't let her leave." The equipment in student health had a limited range. My test didn't generate a number. It just said "high." "High" means it was at least six times normal. No, my life isn't over. It's a pain in the ass, it's terrifying, but the treatments will on average get me through the day. I was waiting for a friend to take me to the ER when Helpful Nurse started talking about high- risk pregnancy and "not dying the way my grandmother died." Pregnancy? I have exams in a month. And I watched my T1 grandmother die. Thanks, Helpful Nurse, you can go now. Of course this was a Friday. I spent the weekend eating nothing but tofu and zucchini with my sugar camped at three or four times normal, and Continue reading >>

Management Strategies For Brittle Diabetes - Sciencedirect

Management Strategies For Brittle Diabetes - Sciencedirect

Volume 67, Issue 4 , September 2006, Pages 287-294 Management strategies for brittle diabetesStratgies de prise en charge du diabte instable Author links open overlay panel M.-C.Vantyghem1 Get rights and content Type 1 diabetes is an intrinsically unstable condition. However, the term brittle diabetes is reserved for those cases in which the instability, whatever its cause, results in disruption of life and often recurrent and/or prolonged hospitalization. It affects 3/1000 insulin-dependent diabetic patients, mainly young women. Its prognosis is poor with lower quality of life scores, more microvascular and pregnancy complications and shortened life expectancy. Three forms have been described: recurrent diabetic ketoacidosis, predominant hypoglycemic forms and mixed instability. Main causes of brittleness include malabsorption, certain drugs (alcohol, antipsychotics), defective insulin absorption or degradation, defect of hyperglycemic hormones especially glucocorticoid and glucagon, and above all delayed gastric emptying as a result of autonomic neuropathy. Psychosocial factors are very important and factitious brittleness may lead to a self-perpetuating condition. The assessment of brittle diabetes requires quantification of the variability of blood glucose levels. To quantify instability, measures which have been developed, include Mean Amplitude of the largest Glycemic Excursions (MAGE), Mean Of Daily Differences (MODD), Lability Index (LI), Low Blood Glucose Index (LBGI), Clarke's score, Hyposcore, and continuous blood glucose monitoring. Once psychogenic problems have been excluded, therapeutic strategies require firstly, the treatment of underlying organic causes of the brittleness whenever possible and secondly optimising standard insulin therapy using analogu Continue reading >>

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