Brittle?
David -
I’m curious about this term "brittle". I’ve always regarded myself as
mostly "normal" - I have my ups and downs and minor problems, but generally
keep good control. And since going on a pump 2 years ago, my control has
been excellent (HbA1c 5.3%, no severe hypos) Then recently two knowledgable
people have suggested - in the nicest possible way - that I am "brittle". I
wonder if the term is coming back into fashion?
I was chewing things over with my endo, and he said that many of his older
type 1’s have very stable bg’s - no dawn effects, no hypo rebounds, no
sudden peaks and troughs, same insulin requirement from day to day. He
suggested that as you get older, the body produces fewer of these
anti-insulin hormones that can make the bg bounce around - the sort of
things that make adolescent control much harder, cause dawn effects, or
make the bg behave erratically when under stress.
Do you reckon this really true? Are we in some way unusual for choosing to
test 8 times a day? I test that often because the information I gain is
useful to me: it puts me in control. For the first time in my life I am not
a hostage to my diabetes.
Should I be envious of people who *can* get good control on 2 injections a
day? Or should I be suspicious that they are not really getting good
control, and sorry that they are willing to force themselves into strict
eating regimes?
A slightly pensive John…
–
November 11th, 2003 at 1:55 pm
I’m with you John, although my HbA1c isn’t that good–I’m usually at 6.5 and
still have trouble with hypos. I test 7-10 times a day because it means I know
what my body is up to and I can respond accordingly. I doubt the 2 injections a
day types are really as well off as they imagine themselves to be, but if they
are–good for them. I most definitely CANNOT get good control without my pump
and frequent testing, so to me it’s a non-issue. I wouldn’t even consider not
testing as often as I feel I need to because others don’t have to. If I reach
the point where I’m not willing to do a test because I don’t want to stick my
finger (after 28 years Type 1), I hope someone shoots me!
Janet
David -
I’m curious about this term "brittle". I’ve always regarded myself as
mostly "normal" - I have my ups and downs and minor problems, but generally
keep good control. And since going on a pump 2 years ago, my control has
been excellent (HbA1c 5.3%, no severe hypos) Then recently two knowledgable
people have suggested - in the nicest possible way - that I am "brittle". I
wonder if the term is coming back into fashion?
I was chewing things over with my endo, and he said that many of his older
type 1’s have very stable bg’s - no dawn effects, no hypo rebounds, no
sudden peaks and troughs, same insulin requirement from day to day. He
suggested that as you get older, the body produces fewer of these
anti-insulin hormones that can make the bg bounce around - the sort of
things that make adolescent control much harder, cause dawn effects, or
make the bg behave erratically when under stress.
Do you reckon this really true? Are we in some way unusual for choosing to
test 8 times a day? I test that often because the information I gain is
useful to me: it puts me in control. For the first time in my life I am not
a hostage to my diabetes.
Should I be envious of people who *can* get good control on 2 injections a
day? Or should I be suspicious that they are not really getting good
control, and sorry that they are willing to force themselves into strict
eating regimes?
A slightly pensive John…
November 13th, 2003 at 4:35 pm
John,
I really have no evidence to support my statement, only supposition.
The term ‘brittle’ goes back to the early days of the Joslin Clinic in
the 30’s, and he was the first one to promote good control using
multiple injections. The Joslin Clinic stayed with this concept during
the years when most MD’s were recommending just one injection of Lente,
NPH, or something like that figuring that was easier and wouldn’t do any
harm. Wrong!
I was in that one injection a day camp for 25 years, and it almost
destroyed me. Maybe the apparent good control (no checking was
available to confirm this in those days) led to the opinion that those
of us on one injection a day were not ‘brittle’ since everything seemed
to work OK, and those using multiple injections were ‘brittle’ because
the multiply injected regular stuff was causing lots of ups and downs.
But common sense tells me that the system responds to the injected
insulin pretty much according to the rules of the endocrine system, as
long as one is a Type I, not manufacturing any insulin. I can not
visualize any mechanism that would cause one type I to be different from
another with respect to how the insulin works in the system, other than
some people will find it lasting longer than others, and some will
require more/less than others depending on metabolism and carbohydrate
consumption.
Go Figure!
David
November 14th, 2003 at 8:51 am
Janet,
With a 6.5 a1c you have nothing to worry about. Most MD’s feel that
trying to do much better will run the risk of frequent hypos; it is
better to be slightly high on a1c rather than risk a bad hypo. I had
that problem until I switched to Humilog, and my a1c dropped about 0.5
almost immediately, and no problems with hypos.
David
November 14th, 2003 at 11:11 pm
Thanks, David! My CDE laughs at me because I get mad when my a1c goes up a
tenth of a point or two–she’d KILL for some of her patients to have my readings
and dedication! I do still have a lot of lows, but it’s mostly because I’m
obsessive about exercise and will keep running on my treadmill until I reach my
goal for that day even if I feel like I’m bordering on death. I guess I’m just
"goal-oriented"! And I think Humalog is one key to my success along with the
pump.
Janet,
With a 6.5 a1c you have nothing to worry about. Most MD’s feel that
trying to do much better will run the risk of frequent hypos; it is
better to be slightly high on a1c rather than risk a bad hypo. I had
that problem until I switched to Humilog, and my a1c dropped about 0.5
almost immediately, and no problems with hypos.
David
November 17th, 2003 at 7:13 am
David, this sure sounds familiar….is there an echo?? LOL
fp
November 18th, 2003 at 2:15 am
Probably and echo…I say this to anyone who will listen…David
November 19th, 2003 at 11:41 am
Hi guys:
cast is off and some stitches are out, so limbering up the fingers!
Brittle is a term we use for diabetics who are not well controlled and have
episodes of both hyper and hypoglycemias. Quite often, I still meet up with
both MDs and RNS who still use the term simply because they are not well
educated on the current trends in diabetes management. Being a "type2" on
insulin, and as we all know on this list, there are many reasons why we are
diabetic. Some like me, who are insulin resistant, others are insulin
dependent simply from infection that caused damage to that wonderful pancreas
of ours, some because of prematurity which stressed out our premature
pancreas and impacted upon it for the future, fact still remains that we
require insulin in order to live, so we live and we pump.
so, yes David, your concepts do have merit and common sense does
prevail..wish we could teach it in medical school, but if they didn’t go in
with it, quite often they come out the same way.
so, slightly pensive John: we have all decided to live a "normal" life and
control our diabetes instead of it controlling us.
and you are right brittle is outdated and tells us a lot about the knowledge
base we are dealing with, so educating and sharing what we know is a good
thing.
remember too, that realistically, we don’t get good control with just 2 shots
a day…I’m sure many of us (including me) were under that misconception.
Dragging around with a bg of 309 is not my concept of a good or fun thing nor
is having a drop down to 49 which has happened bp (before pump).
we all come to an understanding with ourselves and food. Some of us are
better "disciplined" or just so plain scared they just don’t want to live a
normal life but instead live "the diabetic", so take it from there.
Your endo should also learn the geriatric set a bit better…we see an onset
of type 2 in older people either from age, poor control to begin with and
newly diagnosed because of a more thorough MD or NP or PA, infection,
hepatitis, surgery, obesity, lots of things which make someone achieve a
"diabetic" state requiring intervention.
So, I wouldn’t worry about someone only taking however few shots a day. I’m
glad I decided to get me on pump therapy. 8 month anniversary as of tomorrow
and never gonna look back, so take it from there! later, Joan
December 1st, 2003 at 1:46 am
There are many other endicrone problems that have a drastic effect on the
body’s ability to metablise and use glucose. The hyper/hypothryoid, adrenal
glands, sexual glands, liver’s glands and others all have an effect on the
body’s ability to metablize glucose. Diabetes by it self is relatively
straight forward, But when other glands are involved (in my case: Adrenal
insufficency, Hypothryoidism, and diabetes) my response to insulin and/or
carbohydrates is not consistant.
I am prescribed constant amounts of meditcation for adrenal insufficency.
However, the requirements are definently not constant. More medication is
required if sick, stressed(that undefinied word), have fever, or have had
a reaction! A side effect of additional medication is higher blood sugars
(and an increased need for insulin, for an undefined number of hours!)
Note: if a person takes medication for the thyroid, it affects the body’s
ability to metablise food. Obviously, if a person can metablise food, then
the requirement for insulin is increased! If a person forgets there
medication, or takes it twice, it will be desasterious!
We cannot only talk about the workd brittle from the standpoint of a single
disease, as most people with an endriconine problem tends to have more than
one endricone illness. I believe "brittle" is more approtiate for people
with multiple endrocine illnesses.
Until all endricone medications can be acturately adjusted correctly, I
expect to have continue to have lots of high and low blood sugars.