Brittle Diabetes Treatment

Brittle diabetes treatment is discussed in the Annals of Endocrinology published in Paris in September 2006. It was discussed under the title of Management Strategies for Brittle Diabetes and was reported by the Endocrinology and Metabolism Department at Lille University Hospital.

Among other things, the report explained that this condition that is basically unstable is reserved for those whose lives are disrupted due to the instability. By this, they mean those who have been repeatedly hospitalized. Also, the hospitalization has been prolonged.

Although it involves only three out of 1000 patients who are dependent on insulin, the question of brittle diabetes treatment is faced head on. This issue was confronted especially because the prognosis is poor. What are the bases for this poor prognosis?

They arrived at the poor prognosis from the following findings. First, the conclusion was that those who suffer from this condition and so are in dire need for brittle diabetes treatment have lower quality life scores. Also, these patients who are mainly young women have more microvascular and pregnancy complications. Moreover, their life expectancy is shortened.

Three forms of these unstable cases were described. One is recurrent diabetic ketoacidosis. This is a condition that is so severe that brittle diabetes treatment should be promptly given. This could lead to coma and even death.

They called the second form as major hypoglycemic episodes. From my other readings, these are characterized by incapacitation, convulsions, disorientation and loss of consciousness. The third form is mixed instability. Whatever forms they come in though, clearly, there is a need for brittle diabetes treatment.

Now let us go to the causes of brittleness as reported in the Annals of Endocrinology. The report states that the causes include some drugs like alcohol and antipsychotic pills, malabsorption, defective absorption of insulin, deficiency in hyperglycemic hormones and delayed gastric draining due to neuropathy.

I understand all these but how can absorption of insulin be defective? How can this lead to brittleness? Most episodes I know happen at night because that's when the body needs less insulin but this is the time when the intermediate-acting insulin reaches its peak, making the blood glucose drop.

Also, overuse will sometimes harden the skin and this will have an effect on the rate of absorption. Believe it or not, the length of the needle also has something to do with the absorption of insulin, so my other researches say. How? Well the longer needle goes deeper so naturally the absorption is faster.


Have no fear though with using a shorter needle. Advocates just recommend that you leave it in for about five seconds to increase the absorption rate. So you see, insulin injection does not have to be an ordeal. Other people's experiences are all put together to make it easier for others.

Now back to the report where they said that psychosocial factors play an important role in factitious brittle condition. Factitious? That's their word, not mine, but it implies that the condition is not spontaneous but rather it is premeditated and is the result of one's own desire.

I don't understand this because how can anyone want this condition to happen? Well, I'm not a psychiatrist so I will stay away from this issue. I will just stick to what they said in the report that psychosocial factors may lead to a condition that is self-perpetuating.

The report also indicated that in order to assess the condition and to come up with the brittle diabetes treatment, I hope, they say that what is needed is to compute the variability of the glucose levels and so they developed measures to do this. After excluding the psychogenic factors only then did they come up with therapeutic strategies. Here they are:

  • Treat the underlying causes of the brittleness first.
  • Optimize the insulin therapy using analogues, multiple injections and to consider continuous subcutaneous insulin mixture.
  • Alternative treatment should be considered for those who are most severely affected.

What are these alternative brittle diabetes treatment, you asked? One is isolated islet transplantation because according to this report, this restores glucose sensing. The other one is implantable pumps that they say are good for those who weigh more than 80 kg or have abnormal kidney or liver functions.

In the next sections, we will see if the islet transplantation has been successful. If so, where did they do this? And what are the requirements to be considered for this advanced form of brittle diabetes treatment? Hopefully, all these questions will be satisfactorily answered.
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