Brittle Diabetes to Angie

[Guest guest]

> Heidi,

> What does a brittle diabetic mean. I have never heard that term

until I

> heard you mention it on here.

Angie,

In response to your question, I'll paste an article that explains

Brittle Diabetes. Research shows that patients with chronic

pancreatitis-associated diabetes are less prone to complications such

as retinopathy, nephropathy and atherosclerosis, yet neropathy and

myopathy occurs in one third of cp-diabetic patients who continue to

abuse alcohol. Since I don't drink, I don't plan to be one of those

statistics....!

************************************

Brittle Diabetes Mellitus

Higgins, M.D.

Brittle Diabetes is a subjective term and the diagnosis often depends

on the experience of the patient, family and physician involved. The

most useful definition of brittle diabetes is a functional one: " the

patient whose life is constantly disrupted by episodes of hyper- or

hypoglycemia, whatever their cause " . While these patients are rare

(less than one percent diabetics), they cause a considerable burden on

hospital, social, and family resources due to multiple hospital

admissions.

Many early studies tried to identify possible physiological mechanisms

for the brittleness but with increasing study, it has become clear

that the majority of cases are due to psychological factors. Metabolic

abnormalities are a rare cause of poor glycemic control.

Natural History:

Brittleness may be in the form of hyperglycemic brittleness,

hypoglycemic brittleness or a combination of both. Brittle diabetics

followed over a long period of time have been noted to have certain

characteristics:

* Most patients were consistent in whether their recurrent episodes

were hyperglycemic or hypoglycemic in nature. Only occasional patients

showing " mixed brittleness " .

* Women predominate in most studies of brittle diabetes but men

frequently also are found to be brittle. In my own experience,

brittleness is more common during puberty in both sexes.

* There is a significant mortality rate. Among survivors, the insulin

dose tends to drop over time and episodes of hyperglycemia and severe

hypoglycemia become less frequent.

* Diabetic complications seem to be more frequent in brittle diabetics

and are most likely related to poorer metabolic control.

Cause of Brittle diabetes:

It is clear that the brittleness in most patients is related to a

specific unhappy life situation; when this resolves, so does the

brittleness.

Hyperglycemic brittleness is rarely related to a chronic cryptic

infection.

Hypoglycemic brittleness is rarely related to diabetic gastroparesis

where the stomach has a delay in emptying or hypoglycemic unawareness

where the patient can not sense a low blood sugar.

Treatment:

The approach to management will obviously vary depending on the

specific cause in each case. In evaluating a patient with brittle

diabetes (who may have mountainous medical records!), it may be

beneficial to start fresh with a new physician and diabetes care team.

A fresh look is helpful in remaining objective, decreasing the ability

of the patient to manipulate the care team and possibly spot a

metabolic cause which may have been missed.

It is important to take a detailed history and do a detailed physical

exam. It should also be determined if there was a period of " stable "

diabetes preceding the brittleness, and what happened in the patient's

life circumstances coincident with the onset of brittleness.

A diabetic educational assessment is important to evaluate whether the

patient knows how to manage diabetes, and whether the current insulin

regimen is reasonable. In addition, as many as one third of patients

with brittle diabetes have been found to have a " communication

disorder " (which can be diagnosed by speech language pathologists) as

the major cause of their brittleness; specific treatment is beneficial

in 75% of cases.

A psychological evaluation is always warranted, since psychotherapy

has been shown to be effective in selected patients. Family counseling

is also often necessary.

For severe cases of brittle diabetes, a structured hospital admission

may be necessary. Generally these admissions are prolonged, lasting

for two to three weeks. Pre-hospital planning is important and

insurance pre-certification is often necessary. Early in the hospital

course, the patient must be monitored closely and have all diabetes

care done by the hospital staff. Gradually, the patient is allowed to

become more involved in his or her own care. Intensive diabetes

education is necessary as well as ongoing psychological support.

*************************

I hope this explains it.. At the present time, I'm relatively stable,

and only have occasional problems with brittleness. It usually only

happens for a couple days at a time, maybe once every three months or

so, where my BG is either way too high, or too low, without

explanation or due to incorrect use of my insulin.

With love, hope and prayers,

Heidi

Heidi H. Griffeth

South Carolina State Rep.

South Eastern Regional Rep.

PAI

Note: All comments or advice are based on personal experience or

opinion, and should not be substituted for professional medical

consultation.

[Guest guest]

Angie,

It's not that uncommon for people with chronic pancreatitis-associated

insulin dependent diabetes mellitus, or as Dr. Artruro, (a well known

Diabetic Instructor), calls it, PC-IDDM, to have brittle diabetes.

I didn't get any special instruction, but I do check my BG levels very

frequently (6-10 times daily), and make sure that I keep myself under

strict control. My Endo allows me to make any insulin adjustments,

(decreases or increases that vary from my regular guidelines),

whenever I wish without having to consult him. In fact, I only see

him twice a year, unless I ask for a special appointment, or become

hospitalized. With this kind of leeway, I'm able to immediately

adjust my insulin without having to wait for a doctor's approval, and

having this freedom allows me to maintain the strict control that I need.

My diabetes was as a result of my pancreas burning out two years ago.

At that time I'd had chronic pancreatitis for a couple months short

of two years.

When my brittleness acts up, I swing from high to low very rapidly. I

don't actually know whether I " run " high or low, since I keep such

strict control and have to have the insulin to survive, so there isn't

a time when I'm without it. My BG was 1,000 when I had my DKA, and

tests showed that it had been averaging at 860 for three months prior

to being admitted to the hospital, but that was only because I'd been

undiagnosed at the time and not receiving any insulin.

It hasn't been that difficult to deal with so far, yet that could

conceivably change in later years. There's not anything I can do now

to change it, except to continue to monitor myself closely, keep

strict control and do whatever necessary to avoid diabetic

complications, so that's what I do. Thank's so much for your kind

words and concern.

With love, hope and prayers,

Heidi

Heidi H. Griffeth

South Carolina State Rep.

South Eastern Regional Rep.

PAI

Note: All comments or advice are based on personal experience or

opinion, and should not be substituted for professional medical

consultation.