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What Is ‘Brittle’ Diabetes?

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Updated November 29, 2007

Treatment for Brittle Diabetes

Identifying and correcting the underlying issues, whether physiologic or psychological, is essential to treating brittle diabetes. Blood tests can help to determine the cause of glucose instability. If blood glucose responds normally to diabetes drugs in a controlled environment (such as in a hospitalized patient), then one should look for environmental, psychological or behavioral causes.

While there may be a physiological explanation for brittle diabetes, that's only one of the potential behavioral/environmental explanations, and diagnosing a psychological cause of brittle diabetes can often be a lengthy and challenging process.

If the cause is determined to be psychological, treatment may involve exploring and trying to lessen the stress of the person's situation. It is helpful to consult a psychology professional in evaluating and treating these patients. Psychotherapy has proven to be effective in treating brittle diabetes.

Patients with brittle diabetes may sometimes need to be transferred to a different diabetes care team or center for a fresh start managing their diabetes. Switching to a specialty diabetes center can sometimes help to break the cycle of brittle diabetes.

Treating brittle diabetes sometimes requires a prolonged hospital stay of a few weeks with intensive monitoring of food, glucose and insulin.

People whose brittle diabetes is caused primarily by physical, rather than psychological, factors may benefit from a continuous insulin pump to control glucose levels precisely.

Selected patients with severe degrees of brittle diabetes may consider isolated islet transplant or pancreas transplant. While promising, transplantation remains a relatively new therapy and carries significant risks, including those associated with anti-rejection immunosuppressive therapy. Therefore, only people who have exhausted all other means of glucose management should consider transplantation.

The most important component of treating brittle diabetes is close supervision by the patient's diabetes care team to treat underlying causes, ensuring that the patient receives and understands all necessary education, and supporting the patient and family on the path to effective diabetes management.

Sources:

Bertuzzi, F, A Secchi, and V Di Carlo. "Islet Transplantation in Type 1 Diabetic Patients." Transplantation Proceedings 36(2004): 603-4.

Dutour A, V Boiteau, F Dadoun, A Feissel, C Atlan, and C Oliver. "Hormonal Response to Stress in Brittle Diabetes" Psychoneuroendorinology 21(1996): 525-43.

Lehmann R, RA Honegger, C Feinle, M Fried, GA Spinas, and W Schwizer. "Glucose Control is Not Improved by Accelerating Gastric Emptying in Patients with Type 1 Diabetes Mellitus and Gastroperesis. A Pilot Study with Cisapride as a Model Drug." Experimental and Clinical Endocrinology and Diabetes 111(2003): 255-61.

McCulloch, David K. "The Patient with Brittle Diabetes Mellitus." UpToDate.com. 2007. UpToDate. 18 Sep 2007 <http://www.utdol.com/utd/content/topic.do?topicKey=diabetes/6678&selectedTitle=2~2500&source=search_result>

Stacher, G, G Schernthaner, M Francesconi, HP Kopp, H Bergmann, G Stacher-Janotta, and U Weber. "Cisapride Versus Placebo for 8 Weeks on Glycemic Control and Gastric Emptying in Insulin-Dependent Diabetes: A Double Bind Cross-Over Trial." Journal of Clinical Endocrinology and Metabolism 84(1999): 2357-62.

Vantyghem, MC and M Press. "Management Strategies for Brittle Diabetes." Annales d’Endocrinologie 67(2006): 287-96.

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