Wednesday, March 29, 2006

Brittle Diabetes

Thoughts on this phrase?

35 comments:

Scott K. Johnson said...

Hrm. I personally don't like that phrase. Not one bit.

I think it's very "old school" and I must admit that I make an unconscious and unfair mental judgement of the sayers level of diabetes knowledge when I hear them say it.

I mean, maybe you're more sensitive to things than I am, but that just makes your ratios different than mine - it doesn't mean your diabetes is different!

Problems with diabetes management can be very complicated, and layer upon layer deep, but if you have the patience and will to work it out, I think that you probably can.

To write the problems off to your diabetes being "brittle" just irks me.

I once heard somewhere that diabetes is like pregnancy. Either you are or you are not. There are no "degrees" of pregnancy, just like there is no degree of diabetes. Either you have it or you don't. It's like people saying "Goodness, you must have diabetes real bad for you to need a pump, or shots, or whatever". No, there is no "real bad" diabetes. It's just diabetes!

And what's the opposite of "brittle diabetes"? "Ductile Diabetes"?

KWeaver said...

Brittle Diabetes is caused by non-compliant doctors.

Felix Kasza said...

Brittle diabetes? I agree with Scott -- you are sensitive to some factor that is not sufficiently well controlled, never mind (admittedly, witty) remarks about non-compliant doctors.

Unfortunately, some factors are beyond our control, such as large parts of our endocrine (hormonal) response to stimuli.

On the positive side, you _can_ perhaps eliminate a bunch of factors by making sure your basal rates, correction factors, and I/C ratios are well-tested, and by going on a moderate-carb, low-glycaemic-load diet combined with daily work-outs. That worked wonders for me.

Cheers,
Felix.

julia said...

What Scott said.

art-sweet said...

What they said.

Sarah said...

Ugh, I hate that! DH's uncle loves to tell me he tells people he knows with D (usually T2), how I've got "the sugar REAL bad, since I'm on a pump" {roll eyes}.

Ditto Scott.

J said...

oh geez this phrase is about as good as when you say I have diabetes and someone says " is is serious" ummm HELLO ! it is diabetes how more serious can it get ! yes my english skils are flurishing today :-) lol

Megan said...

While I know brittle diabetes used to be used years ago, my experience is that people who use it currently really have no interest in control. They use the term "brittle" as an excuse.

They know nothing about diabetes, how it is managed, nor do they care to learn despite having high speed internet, an endocrinologist, and a nearby library.

They are on N and R or 70/30 and not willing to take more than 2 shots a day. They test twice a day too- if that. And they have no idea what a carb is or what is high carb or low carb.

And then they complain about poor bs control.

That's just my experience with people who call themselves brittle.

That said.

I do think some people have a harder time managing diabetes than others. Personally, I think mine is really easy to manage right now. But I am honeymooning, on multiple daily injections, and typically test 6 times a day. I count every carb and inject appropriately. I log everything. So I put forth the effort.

I think some of what makes some people's diabetes harder to control is simply different circumstances. If you are highly active, have other chronic illenesses, or are financially unstable, you are gonna have a hard time managing diabetes.

But I don't like the term brittle. If your diabetes isn't in control, change what you are doing- it's not working.

Anonymous said...

I'm an RN and a T1 diabetic. Years ago I came to realize that a "brittle diabetic" is one who refuses to take the measures available to be in control of their diabetes. My hubby is also a T1, for about 30 years now--for many years he suffered from a lack of diabetes education, but 10 years ago received a pump, and education, and now his A1Cs are in a great range (not over 6.4). Years ago his bgs varied from 40 to 450 on a daily basis. Thank goodness, he hasn't had any complications to date! So much for the "brittle diabetes!"

Anonymous said...

I'm an RN and a T1 diabetic. Years ago I came to realize that a "brittle diabetic" is one who refuses to take the measures available to be in control of their diabetes. My hubby is also a T1, for about 30 years now--for many years he suffered from a lack of diabetes education, but 10 years ago received a pump, and education, and now his A1Cs are in a great range (not over 6.4). Years ago his bgs varied from 40 to 450 on a daily basis. Thank goodness, he hasn't had any complications to date! So much for the "brittle diabetes!"

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JET said...

I think one of my biggest fears about diabetes is the shots and needles.
I am not diabetic yet, but I fear I will be some day.
My grandfather took an extra pill yesterday by accident and need to go to the ER last night.

Carol said...

I ran across your blog on brittle diabetes. My brother-in-law is doing poorly and my sister says it's because he's brittle.

This has been helpful reading your comments...I felt that they are not eating correctly and he isn't taking care of himself. He does test and takes insulin shots 6 times a day. But his blood sugar level dips so low and goes so high, and he was in a bad low blood sugar crisis two nights ago.

Do you find that the "counting carbs" diets don't work? I personally think he might do better by going low-glycemic and eating all he wants to.

Can anyone give some suggestions?
Thank you. Carol

Nikki said...

Hi Carol. I think anytime you are giving fast acting insulin injections, counting carbs is the only way to go. I suggest he stick with it, but monitor his blood sugar more regularly. Most of us check our blood glucose 8-10 times a day, or even more than that! Let me know if you have any other questions. Thanks

GistOut said...

"diabetes is like pregnancy...."

Just a notification of being cited as quotable metaphors/analogies in "Archive of Metaphor and Analogy".
Thank you.
http://gistout.com

Anonymous said...

Brittle Diabetes is a medical term meaning that it is exceptionally difficult to control. Marked by alternating episodes of hypoglycemia and hyperglycemia. Frequent adjustments of dietary intake and insulin dosage are required. Diabetes is diabetes, however there is no need to question someone's knowledge level because they use the term brittle. The term is not used as often, but it is a medical term used by doctors and there is no need to be sensitive about it. Everyone's diabetes is a little different and we all must deal with it the best that we can. As human beings we all have different levels of coping ability, so call it whatever makes you feel better and don't get caught up in semantics.

Anonymous said...

What a bunch of very fortunate people, there is more than type 1 and type 2 - if you ask any dr with more than a passing glance at diabetes you would learn - some people do not accept insulin as well - no matter the delivery method. Reasearch before you banter off.

Diabetes Supply said...

Persons with diabetes should keep their blood sugar at a healthy level to prevent or slow down diabetes problems. Ask your doctor or diabetes teacher what a healthy blood sugar level is for you. Your blood sugar can get too high if you eat too much. If your blood sugar becomes too high, you can get sick. Your blood sugar can also go too high if you do not take the right amount of diabetes medicine. Diabetes Symptom at http://diets-diabetes.blogspot.com

Diabetes Supply said...

Persons with diabetes should keep their blood sugar at a healthy level to prevent or slow down diabetes problems. Ask your doctor or diabetes teacher what a healthy blood sugar level is for you. Your blood sugar can get too high if you eat too much. If your blood sugar becomes too high, you can get sick. Your blood sugar can also go too high if you do not take the right amount of diabetes medicine. Diabetes Symptom at http://diets-diabetes.blogspot.com

Colette said...

I was diagnosed at age 50 with latent autoimmune diabetes and was immediately started on flexible insulin therapy. I inject 5-6 times a day and test at least 8 times per day. After 2.5 years, today my doctor used the term "brittle" to describe my condition. It was very upsetting since I constantly monitor what I eat, count carbs, use correction doses, etc. This word "brittle" just kick started my motivation to improve my A1C!

Diabetes Supply said...

At first, your blood sugar level may rise so slowly that you may not know that anything is wrong. One-third of all people who have diabetes do not know that they have the disease. If you do have Type 2 Diabetes Symptom, they may include: Feeling thirsty. Having to urinate more than usual, Feeling more hungry than usual, Losing weight without trying to. http://diets-diabetes.blogspot.com/

caretaker said...

i take care of my mom at home and she was diagnosed brittle about ten years ago, she's had type one for 52 years and has always done well until this, she tests at least 6 times daily and watches her diet carefully but it seems to be so unpredictable, she takes four shots a day. one minute her sugar will be 37 and a few hours later it can be 350, any suggestions?

Todd said...

PEOPLE...listen, the purpose for "brittle" is a one word summary of everything you are saying. Of course you have diabetes or not. All of you say that people just have different ratios, reactions, etc. Well it is easier to say Brittle. Do you say my family had cancer, so due to me having a similar chemical makeup, I, too, am likely to have it? Or do you simply say, "hereditary."

purplejet5 said...

It really irks me when people start putting everyone who says they are a brittle diabetic in a category of "I don't take good care of my diabetes" attitude. My dad and I are both T1 diabetics and the doctors call us "brittle." I check my sugars 8-10 times a day, on the insulin pump, but have such severe hypoglycemic episodes, I'm in the hospital once a month. I also see my doctor monthly instead of every 3 months. I watch my carbs very carefully but my body responds to the same foods differently everyday. I end up in the hospital so much because I can't sense when I get low AND whenever I have any type of infection (before my body gives me symptoms in it) my blood sugars go from high 70's to low 30's with in 5 minutes and don't have anytime to react before I can't take care of myself anymore.
My dad is also labeled "brittle diabetic" for the past 10 years of my life. His blood sugar drops so drastically fast too ends up having seizures in the middle of the night, about once a month. He checks his sugar 6-8 times a day and can be in a safe range at one time and then an hour half an hour later he is seizing. He use to not be so "brittle" but over time he doesn't feel the symptoms of getting low.
Many doctors have told both my dad and I that our diabetes is very complicated and doesn't follow the book of a regular diabetic. I don't disagree that if your diabetic, it sucks all around, but I do not agree when someone puts a "brittle diabetic" in a category that they don't care for their diabetes and if they started it would be in better control. One person in the blog said it really depends on other relying illnesses too. Yes, I also have neuropathy that makes it so I can't sense when I am low, but my dad has just been a diabetic for almost 30 years and his symptoms are not there anymore.

Anonymous said...

I agree with purplejet5. I have brittle diabetes, am on an insulin pump, and my sugar also drops very quickly. If it gets under 150, it never stops dropping. I test up to 18 times a day, including in the middle of the night. I think an insulin pump with smaller doses may help. I have a Medtronic pump...are there any that give .00 doses in the bolses? I need to give 1.05 instead of 1 to keep it in range, for example. I also think hormones swings (I'm a woman) really mess with my bg levels and it makes things really difficult. My last endoc told me that my case had no patterns so she didn't know what to change, so I'm looking for a new one. This is my 5th endoc and none of them know what to do. I need a Dr. House of diabetes. Anyone know a Dr. House? Seriously, don't group everyone who is brittle into a bad category. Some of us are doing everything we can to keep our levels down (I've even tried not eating to see if my basals needed to be changed.) and it's not working. This is a true brittle diabetic.

Anonymous said...

addition to my last posting in response to purplejet5...I should also mention that I have had type 1 diabetes for more than 10 years and I have a nutrition degree. I'm very well educated in the disease and what it takes to manage it. Unfortunately, I too have a case that is not textbook and nothing seems to work.
We're all in this together, and it sucks for all of us, so let's try to get along and help each other.

Anonymous said...

Totally agree with purplejet ..you can't say that all people who struggle to manage their diabetes are not taking care of themselves. I am a Type I with diabetes for 31 years. I have been on a pump for 10 and it has done some good, although I'd say that I classify myself as a "brittle diabetic". I recently went on a continuous glucose sensor and that fortunately has provided some phenomenal insight into why my sugars tends to fluctuate. As a female, hormones have a major impact on my BG levels; stress is an issue too. The sensor has helped to notify me when I am at risk of a low ( and this has been my major challenge, with lows sometimes 5 - 6 times in a day). I have followed the textbook under a team of great specialists and engage in a regimen of a stringent diet, regular moderate exercise, and aggressive pump therapy. My weight is in the norm BMI range and has not fluctuated. So, given all the talk about "brittle diabetes" being attributed to a lack of care and/or poor self management, I disagree. I would offer that we encourage all of those with this disease to manage it the best way they can; to offer the support needed and to provide a forum for sharing how best to manage the challenges it brings.

For the person who is a female and who has had trouble finding the "patterns", you might want to look into a continuous glucose sensor. Have been on it for 3 months and my A1C went from 7.1 to 5.9 based on access to valuable trend data!!

Anonymous said...

Thanks! Which continuous glucose monitoring are you using? Are you using the Medtronic one? I asked my doctor about the watch before, but she said it wasn't that accurate and had a lot of false highs and lows. Do you find that's true with the method you use? If you use the Medtronic sensor, how big is it? It looks like it's almost as big as the pump in the pictures. Does it get in the way a lot? Does the needle hurt and is it teflon like the pump 'needle'?
Thanks for the insight! I'm glad to hear that it may be my hormones making my sugars go crazy. None of my docs have believed me or wanted to test that.
Thanks again for the help! I too have a lot of lows...I'm waiting of the pump with .000 options in the bolus amounts. That should help those of us who are really sensitive to the insulin.

I look forward to reading your response.
-S

Anonymous said...

I am on the medtronic CBG sensor. It is not as large as the pump - about 2.5 X 1.5 inches in size. The photos scared me - made me think "oh my - what's that going to be like". Just like the pump, the sensor took some getting used to. Insertion hurts a little bit more if you hit a tender or area with less body fat. Insertion requires an inserter (unlike the optional inserstion devices for infusion sets for pumps), and the needle does have a teflon sleeve. Needle pulls out and leave the sleeve in place. The biggest challenge with the sensor is calibration to ensure that the readings are accurate. Once you get used to when you should calibrate and when you should not, you are good to go. I have found that I can wear a single sensor for up to 5-6 days assuming there are no issues with the insertion site.
I am of the opinion that once you get used to the sensor, you really get to a point where you can't imagine not wearing it. Just being able to look down at your pump to see a reading is a pleasue, also being able to catch your BG readings on the rise or decline.

Anonymous said...

Thanks! What does the calibration involve? Do you find that the continuous glucose monitoring is accurate? Can you put the sensors anywhere else besides the abdomen?

Anonymous said...

Does it really matter the term to define a hard-to-manage diabetic. My daughter was 10 when we learned she was type 1. When I started researching because we were having such a hard time with her sugars I was dishearten to learn that people were so critical. I am convinced she is a brittle diabetic. This past year was a nightmare for us both. She and I did everything we were asked. When I would call in her sugars the nurse accused us of lyng saying there was no way she was taking her insulin. I was so offended. So was my daughter. I really wish the professionals in the field would get their act together. I personally don't like the term "uncontrolled". I would very much like to switch doctors but our insurance is limiting my choices. We already travel almost two-hundred miles round trip frequently. As of now, my daughter and myself are still struggling but since she's gotten on the pump in November she is doing much better. She is now 13 and getting use to the ups and downs. I've seen her near death a few times and ,trust me, I don't want to see her die.

Anonymous said...

I have to agree with purplejet Brittle Diabetes does not always mean lack of control or education. I have T1 and have had for over 20 years. I have resantly had 2 heart attachs and three setens put in. My early years of diabetes were not very well controled due to lack of knowlage and financies for my supplies. Since my heart problem I have done nothing but follow a heart and diabetes diet and done everything I am told by doctors to control my sugers. I have been lable brittle due to the fact that I can eat somthing
"Free" like a dill pickle or suger free jello and my suger level will go from 150 to 300 in an hour. They cant figure out why cuz its not in the text books. I have even gone as far as to measure every serving tp actule size and this doesnt matter either. I hate this title and the condition sucks doesnt even cover it. My sugers also can go from 350 to 30 in an hour they are very eratice. They have changed my meds and nothing is doing as it should. So to scott before you start lableing people who use the term brittle as under educated or not taking fcare of ones self. You might want to hear there whole issue.

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it's a start? said...

I totally agree with anonymous and purplejet about brittle diabetes. I have been a nurse for 10 years, and my sister is a brittle diabetic. I have never seen a more brittle case in my life. She wears a continuous glucometer now (dexcom). It checks her sugar every 5 minutes and alarms her for <80 or >200. She has had 3 seizures alone this week. She has had a seizure right after she has eaten before without even taking any insulin (other than what little long-acting is in her blood stream). I am grateful to find this site where I can find people who have had this experience. Let's face it, alot of 'brittle diabetics' are probably somewhat non-compliant, but not ALL are. I think sometime Dr's classify them that way just because it drives them mad not being able to objectively diagnose it.