Brittle Diabetes Mellitus

Brittle Diabetes is a subjective term and its diagnosis often depends on the experience level of the patient, family and physician involved. The most useful definition of the disease brittle diabetes is a functional one; which is "the patient whose life is constantly disrupted by episodes of hyper- or hypoglycemia, whatever their cause". While the patients of the disease are rare, less than one percent diabetics, they cause a considerable burden on social, hospital, and family resources due to multiple hospital admissions.

Many early studies on the disease Brittle Diabetes 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 actually an unusual cause of poor glycemic control. Brittleness can also be in the form of hyperglycemic brittleness, hypoglycemic brittleness or a combination of both. The patients of Brittle diabetes mellitus followed over a long period of time have been noted to have certain characteristics like, most patients were consistent in whether their recurrent episodes were hyperglycemic or hypoglycemic in nature. Only intermittent patients showing mixed brittleness.

Women predominate in most of the studies of the disease brittle diabetes mellitus but men frequently also are found to be brittle. Brittleness is actually more common during puberty in both sexes. There is a considerable mortality rate. Among the diseased survivors, the insulin dose tends to drop over time and episodes of hyperglycemia and severe hypoglycemia become less frequent. The complications of the disease Brittle Diabetes mellitus seem to be more frequent in brittle diabetics and are most likely related to poorer metabolic control. It is clear that the brittleness in most of the patients is related to a specific unhappy life situation; when this resolves, so does the brittleness.

Hyperglycemic brittleness in the disease is rarely related to a chronic cryptic infection. Hypoglycemic brittleness is rarely related to the condition called diabetic gastroparesis where the stomach has a delay in emptying or hypoglycemic unawareness where the patient can not sense a low blood sugar. The approach to the effective management of the disease will obviously vary depending on the specific cause in each case. In evaluating an acute patient with brittle diabetes who may have mountainous medical records! It can be beneficial to start fresh with a new physician and the health care team. A fresh observation 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 very important to take a detailed history of the condition and do a detailed physical exam. It should also be determined if there was a considerable period of stable diabetes preceding the brittleness, and what happened in the patient's life circumstances coincident with the onset of brittleness. A Brittle Diabetic educational assessment is important to evaluate whether the patient knows how to manage diabetes, and whether the current insulin regimen is reasonable. Additionally, as many as one third of diabetic 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.

• Juliana Breckinridge
• 17/02/2009, 6:59 AM
• 0 Comments