Brittle Type 1 Diabetes Insulin Therapy Limitations

Brittle Type 1 diabetes insulin therapy is vital because without it, the fundamental building blocks of the body will not be stimulated for delivery to the muscle cells. The end result will be the prevention of the muscle tissue build-up. Thus with uncontrolled diabetes, the body gets worse because of lack of muscle tissues.

So the Service de Diabetologie-Metabolosme, Groupe Hospitalier Pitie-Salpetrebre in Paris, France studied the brittle type 1 insulin therapy and found some limitations. They published their findings in Diabetes Metabolism in September 2005. How did they conduct the study, you asked?

First, they defined intensive insulin treatment by basic prandial (meal) insulin therapy. This would try to imitate physiological secretion of insulin. How did they accomplish this? They required 3 to 5 injections and checking of the blood glucose level 4 to 5 times a day.

They found that the patients who accepted their condition and the difficult brittle type 1 diabetes therapy routine realized an A1c reading of less than 7.5%. So they were able to prevent the harsh complications without increasing the chances of severe hypoglycemic episodes.

It is sad to say though that 50% of Type 1 patients did not achieve the desired result, that is, their A1c reading did not reach less than the 7.5%. They found that the causes of this failure is three-fold: the diabetes itself, the patient or the physician. Let's take these reasons one at a time.

Well, severe and recurring hypoglycemic incidents in brittle diabetes along with persistent hyperglycemia after meals stops the patients from reaching the best glycemic goal. We know that foods that release sugar rapidly have a high glycemic index while those that release sugar slowly have a low glycemic index.

So how can one achieve an ideal glycemic goal when one day you have a hypoglycemic episode and then after a meal you have hyperglycemia? Really, this shows the importance of glycemic index in fine-tuning the self care routine that brittle type 1 diabetes patient has to undertake.

Frequently, the main difficulty is associated with psychological problems. What are these? Well there's the difficulty in sticking to the self-monitoring routine for one thing. Then there's the denial of the condition. Why me, there's nothing wrong with me, that type of reasoning will certainly lead to avoid what has to be done. The fear of hypoglycemia will also play a part in the avoidance behavior.

Often, young women have eating disorder and this certainly does not bode well with controlling the disease. This one limitation of the insulin treatment will certainly lead to the failure in achieving the blood glucose level target.

The doctor may also be implicated in the failure to achieve the desired goal. How? He may have not prescribed the right tools to reach the target. For example, the report seems to imply that perhaps just staying with two daily injections with premixed insulin may help better.


Or the doctor may have assigned glycemic target that is not accessible to the patient. Then there has to be an emphatic relationship between doctor and patient. This will help develop patient empowerment that is a key to successful brittle 1 diabetes insulin treatment.

The relationship with the doctor is of the utmost importance. Since the patient will have a subjective view of what is needed, the doctor's objective method will be able to point out to the patient what he may have missed in his day-to-day self-care routine.

Despite the limitations of this study on intensive insulin therapy, I am glad they did it because it will form a block for succeeding studies to build on. Hopefully, someone will find a way to eliminate these limitations which will ultimately help those who need this insulin therapy.

For example, there may be a need to have a multi-disciplinary approach to the problem. With all the things a doctor has to do, with glycemic index, he may need the help of a nutritionist. This might help improve the prospect for a successful brittle type 1 diabetes treatment regimen.

Nick Jonas is a popular guy but diabetes does not choose people based on popularity. He developed type 1 diabetes and on August 6, 2008 he held a press conference in New York on his struggle with his condition. Tiger Beat and BOP was there to get it all. Hear what he had to say in this video:

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