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[IPk] Re: 'brittle' diabetes

Subject: Re: [IPk] Medics' reaction to the pump
'brittle' diabetes seems to be used by some to refer to a state with
fluctuating (mostly high?) blood glucose which has not responded to
'the usual treatment' - since definitions of 'the usual treatment' vary
greatly from archaic regimes with two injections a day to flexible
lifestyle with pump etc - I agree entirely that brittle, like the
'UFO', obviously includes a multitude of sins (on the part of the
medical profession).
However while I started out 3 years ago, newly diagnosed Type 1
diabetic, wearing my intelligent scientist's hat, believing that all
was soluble, and that probably 'brittle' was only a useful label
meaning, as written below, 'reasons for fluctuating blood glucose have
yet to be identified', with the implication that once they have been
understood they can also be dealt with.  
After a great deal of frustration, I have stopped believing that it is
that simple, at least for some of us.  I now believe that the
glucose/insulin control mechanism of the body is too complex to be able
to second guess its wondrous ways all the time, that some people seem
to be more variable than others.  For myself, I believe that I cannot
achieve normal blood glucose levels all the time, even being very
obsessional about every gram of carb, and allowing for the effects of
protein and fat eaten together with the carb, and the glycaemic index
of all the carb, and physical activity before/after eating, and whether
blood glucose was above or below some magic number at the time of
starting the physical activity, and emotional stress (how do you
quantitate that???) etc etc for sure there are other factors I have
neglected to mention, but you should get the picture.  I have come to
the conclusion that trying to make accurate calculations about all
these things all the time is a good recipe for ongoing frustration,
that I am better off accepting the term 'brittle' and feeling happy
that I have tools like a reliable glucometer and the pump to help me
live a flexible lifestyle, and correct rapidly for the fluctuations in
blood glucose which occur with a vengeance.

St. Thomas's are saying that your diabetes is not in control, and they
have not been able to identify why (unexplained diabetic
occurrences???).  Guys are saying that sticking a 'UFO' or 'UDO' label
on you doesn't help at all, so they're not going to do it, they're 
to keep at it until they find out _why_ you are not stable, and then
stick a label on that.  The cause could be anything from you having
extreme sensitivity to the glycaemic index (i.e. a meal with 40g CHO 
from wheat is going to do seriously different things to the same meal,
with the wheat removed and replaced with rice), undetected night-time
lows every night, or very poor and erratic absorption of medium and
long-acting insulins.  There are dozens of the <expletives>.

Personal, I prefer Guy's approach - if you've got brittle diabetes,
you're stuck with it.  But if you are trying to find out why you do the
things which in most diabetics would get you great bgs, and you don't,
then you've a chance.  The A&E consultant doesn't have to find an
answer, just a label.  And 'this patient has diabetes which is not 
control, but I don't have the foggiest idea why' doesn't sound good.
But it's the truth.  Just like 'there's something up there in the sky,
and I don't have the foggiest idea what it is' is the truth behind UFOs

Best wishes,


In message <000001c0975d$2d3b7d40$email @ redacted>, Hilly Beattie
<email @ redacted> writes
>What are people's thoughts on the term "brittle diabetes" as my 
>at Guy's says it doesn't exist and is an archiac term, but the A&E
>consultant I saw at St Thomas' tells me this is what I have? It's not
>something I have come across before (and am not sure it would help the
>struggle to have something to blame on the constant high bloods 

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