Dx’d young and out of control
Chrissy wrote:
>>> Needless to say I had many years of uncontrolled diabetes and was in the
hospital ALOT!!! Thank God I dont have alot of complications. I do have
several but it could have been alot worse. Since I have been diabetic for
33yrs now. Thank God we both survived the early years right. Take care.
Chrissy >>>
Chrissy,
I too was dx’d at 11 and had uncontrolled DM for a lot of those years. Mom
said I often had-fruity smelling breath but since she expected me to die
anyway, it was probably just a confirmation to her. But my Q to you is, what
put you in the hospital? When I was 23 and pg I was vomiting and sick *with
flu* and doctor made a house call. He did an acetone test (no ketones then)
and it turned purple so he admitted me, but we never took me to the hospital
for anything else - other than the coma at dx. What were your indications to
go?
August 20th, 2006 at 12:48 pm
When I was younger I wasnt in the hospital but in my teens and early 20s I
was. I was in a coma once for a night. I had been sick at home (I think it
was just because my BGs were out of control.) I was taken to the ER where the
last thing I remember is getting a cathetar and begging for water. In my 20s
and up until the pump if I got the flu I usually ended up in the hospital
because my BGs would soar and Id be spilling ketones like crazy. I have
spent alot of time in the ER also for the same type thing. Back when I was a
kid (after diagnosis) I remember being thirsty all the time. Im sure I was
never in control. My Mom never was and still isnt good about going to the
doctor. She would never take us unless we were dying and even then it was
well OK. I had appendicitus once and she wouldnt take me to the hospital
until the pain got so bad I couldnt take it. Anyway thats another long
story. I dont know if this answers your question or not. Chrissy
PS: Before pumping I was considered a brittle diabetic. My BGs would
fluctuate greatly sometimes for no apparent reason.
August 21st, 2006 at 8:42 pm
Your remarks bring up one subject that has always bothered me; maybe others can
comment.
What is a ‘brittle’ diabetic?
It seems to me that any Type I is by definition ‘brittle’. The term is
meaningless in the modern concept of the problem.
Most (probably all) Type I diabetics will go up to the moon and down to the zoo
with minimal difficulty if care is not taken in treatment.
David
August 22nd, 2006 at 5:26 am
To me brittle means that even if care is taken in treatment you have ALOT of
unexplained BGs that vary greatly. I did everything I was supposed to.
Followed all the rules…even made a flow chart of my BGs and still had
trouble even w/the insulin adjustments the doctor made. So this to me is
what being brittle is. Chrissy
August 22nd, 2006 at 12:57 pm
Good point!
But, I remember back in the 1950’s, before pumps and even tight control (except
at the Joslin Clinic), the term ‘brittle’ was used to differentiate types of
type I patients.
I think that was a bum description in the context of the times. I think it
more applied to MD’s who were treating most patients with one injection of NPH a
day and nothing else; those who had problems with the regimen were by definition
‘brittle’.
David
August 23rd, 2006 at 11:29 am
Funny, I was just contemplating this the other day. I think the
definition depends largely on who is using the term. A lot of older,
or poorly informed doctors consider anyone who doesn’t have their
blood sugars below 200 at all times brittle. Others consider anyone
who has large swings brittle. Still others, and this I think is the
most informed school, consider brittle to be difficult to control due
to problems with absorption, major insulin intolerance, and poor
response to treatment. Of course there are those who believe that
brittle diabetics are always those who don’t pull their weight in the
team control model, or who are non-compliant patients.
I’ve always had extreme swings and a super-sensitivity to insulin.
My body overcompensates to low blood sugars on an irregular basis.
Before the pump I would often go for treatment of ketoacidosis while
my blood sugar was registering low, simply because the rebound highs,
followed by the rebound lows would completely drain the sodium out of
my body. The only doctors I ever had label me as "brittle" were
those who believed my control issues were totally due to non-
compliance.
I wonder what definition for the term "brittle" they are using in med
schools these days? Maybe I’ll try contacting someone at IU Med and
see if I can find out!
suzanna
August 24th, 2006 at 9:30 am
I’m supposing IU med is Indiana Univ.? Are you in Indiana? I’m in
north-central Indiana. We have at least one other one here from central
Indiana.
Jan (~_^)
August 24th, 2006 at 7:59 pm
Yes, IU is Indiana University. I am in Fishers/Indianapolis. I went
to IUPUI for several years in a bio-chem major. I also worked at IU
Med just before they become Clarian (the announcement went out just
weeks before I quit). I also have some friends in another support
group who are approaching the Dean of Medicine re: autonomic problems
and proper education of future physicians. So I might be able to get
some really interesting information re: the actual definition of
a ‘brittle’ diabetic. It may take a while though. I’ll keep y’all
posted.
Suzanna
August 25th, 2006 at 9:53 am
Suzanna,
I’m supposed to be in Indy 6/23 and probably 1:00 p.m. at Shapiro’s Deli, 800
Block of S. Meridian - with a group of ‘netters if you’d like to meet.
Probably at least 2 others from this group will be there, too.
Jan °Ü°
August 26th, 2006 at 5:57 am
David,
Being an "oldie" like Chrissy, brittle was used when now they say unstable.
And no it does not fit all Type 1’s. As individuals our bodies all respond
differently, as you know. Some of us we very "brittle" or unstable during
growth spurts. Some of our bodies are more reactive to adrenaline. Some of
our bodies are more responsive to hormone fluctuations. As adults many of
us respond to anger, worry or stress differently. Some go high and so go low.
This is only my opinion and understanding of what was meant as brittle.
Gail
August 27th, 2006 at 3:29 pm
That would be interesting to know. I never knew there were so many different
meanings for brittle. Hmmm…… Chrissy
August 28th, 2006 at 10:20 am
Actually, I believe "brittle" is one of those terms which has fallen out of
And will you hear drs. still use it–of course, especially
use, like "juvenile" diabetes and "borderline" diabetes. And no, don’t quote
me on that!
GP’s who are not diabetic specialists.
My understanding of "brittle" was someone who did what they were supposed to
do, but still had wide swings in bg’s, even over a very short period of
time–say, from 30 to 400 and back within an hour. I’m using an extreme, but
you get the idea. In other words, diabetes which was almost impossible to
control, despite best efforts..
Patrick
The NC bluegrass pickin’ pumper
August 31st, 2006 at 4:04 am
> That would be interesting to know. I never knew there were so many
different
> meanings for brittle. Hmmm…… Chrissy
Including peanut?
August 31st, 2006 at 12:12 pm
And, back then we got one shot a day of NPH/Reg mixed with just those awful
pee tests and NO HbA1c’s yet either. We did know when we hit a low, though,
and often would eat the fridge to get out of it. The best thing about the
*Good ol’ days* is, they’re GONE!
September 1st, 2006 at 12:36 pm
<< Your remarks bring up one subject that has always bothered me; maybe
others can comment.
What is a ‘brittle’ diabetic?
It seems to me that any Type I is by definition ‘brittle’. The term is
meaningless in the modern concept of the problem.
Most (probably all) Type I diabetics will go up to the moon and down to the
zoo with minimal difficulty if care is not taken in treatment.
>>
Hi David: for those of us working in the hospital and office, we called
diabetics "brittle" when their levels would ping pong and not stay stable.
The was before the onset of pump use. We’re learning so much more. If you
want to check it out further go to aace.com (clinical endocrinologists)
there’s a substantial printout you might like to download or make a hard copy
of….Joan:))
September 1st, 2006 at 8:43 pm
<<
But, I remember back in the 1950’s, before pumps and even tight control
(except at the Joslin Clinic), the term ‘brittle’ was used to differentiate
types of type I patients.
I think that was a bum description in the context of the times. I think it
more applied to MD’s who were treating most patients with one injection of
NPH a day and nothing else; those who had problems with the regimen were by
definition ‘brittle’.
>>
Very True David, and still is a poor excuse that is still being used.
Diabetics should be followed by endocrinologists, not general practitioners
or internists. I tell my HIV + patients the same thing…Joan:))
September 3rd, 2006 at 5:13 am
> Diabetics should be followed by endocrinologists, not general practitioners
> or internists. I tell my HIV + patients the same thing…Joan:))
However, I’m thinking of switching to an internist who specializes in DM cuz
my endo is not keeping up with what he started almost 20 years ago. He is so
far behind the pumping scene it’s pitiful. I got a phone call the other day
from one of his patients endo had call me to give him some websites on DM -
this pt needs help. The CDE (whom I have not seen) says it’s ridiculous to run
more than one basal a day! There are internists around here who have far more
knowledge about pumping than the *best* endo.
September 3rd, 2006 at 11:22 pm
My current doc is an internist who is also a board certified endo. A major
portion of his practice is a diabetes clinic and he employs a CDE and dietitian.
When I was first dx’d, my regular doc sent me to an internist/diabetologist. In
some ways I really liked him and he did a good job, but it was clear he was
accustomed to T2s. He completely missed my T1 dx and DKA. He also told me that
I
only needed to test 2x a day (that was after my re-dx to T1). When I called him
late one Friday afternoon with 400+ BG and very large ketones, he suggested I
meet
him at the hospital — the NEXT DAY. It took lab work to finally convince him
that I was a T1 and not a T2. Once released though, he called me often at home
to
see how I was doing and got me an appointment with a surgeon pronto when my
gallbladder needed to come out. But overall, he was an internist/diabetologist
stuck in the past, not interested in pumps, MDI or tight control. The *right*
internist can make a world of difference.
Connie
J Hughey wrote:
September 5th, 2006 at 6:20 pm
Joan,
That aace.com site is great! I presume you mean the document titled
‘revised diabetes guidelines’ about 43 pages. Since I have double sided
printing capability, it looks like a keeper.
David
September 7th, 2006 at 11:34 am
VERY FUNNY!!! (You are too silly Jan.) Chrissy
September 9th, 2006 at 2:53 am
> wonder what definition for the term "brittle" they are using in med
> schools these days?
From what I’ve "heard," they are trying to ‘do away’ with the term "brittle
diabetic."
September 10th, 2006 at 2:08 am
Jan,
Well, I’ll definitely try to make it to Shapiro’s…I might have a
small time conflict, but can hopefully work it out! Sounds like a
good time!
Connie,
Yes, there is a pump group that meets at Roche. I haven’t managed to
make a meeting in a while, and they’ve changed their schedule. I
think they are having meetings every other month. I got a snail mail
postcard, but who knows where it ended up? (I’m not much of a house
keeper, but that is in the process of changing!) The only reference
I can put my hands on just now is a Dec 2000 newsletter from the
Indiana Diabetes Center (IU Med). You should be able to get actual
dates/topics by calling 274-3500. In the past it was on Monday or
Tuesday evenings around 6:30 or 7:00.
Suzanna