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Permalink Reply by D.D. on June 3, 2010 at 5:01am

Thanks for sharing TIm. I saw my rheumatologist yesterday and he thinks I'm a T1.5 - (which is really a T1 and a little more complicated (a "wierd" category as he said...) I think my endo is leaning in that direction. When I see my endo next month I'm going to ask for all of the antibody tests for T1 which are the ICA (islet-cell antibodies, (IAA) insulin autoantibodies, and antibodies to glutamic acid (GAD - decarboxylase- my rheumatologist gave me an 8-page print out from his physician's web site which I'm working my way through. With diabetes I'm always learning something new and to hear your story (and everyone else' too...) really helps me a lot. Since I've started taking metformin again (still using Lantus at night - 9 units) my bg has definitely evened out - my fasting this morning was 120. Hope this lasts. I'm getting ready to go meet with a landowner (I write Forest and Wildlife Mgmt Plans). I hope to stay out of the ticks and not get any chiggers! See ya! DD

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Permalink Reply by Brian (bsc) on June 3, 2010 at 5:07am

The term "brittle" diabetes was historically used to characterize patients that had a difficult time attaining control. It refers to recurrent large swings in blood sugar. Today, we understand that for the most part brittle (or labile) diabetes is a rare disorder. You don't have "brittle" diabetes when your infurion set fails and you don't have it when you don't bolus or correct properly. It was initially thought that labile diabetes occured when your pancreas totally pooped out, making proper control difficult, but today we know that is not an issue and does not cause labile diabetes. You have labile diabetes when your blood sugar skyrockets for no apparent reason, sometimes sending you into DKA. There might be a few members here that experience brittle/labile diabetes, but this condition is really very rare and not well understood. If you want to learn more read (http://books.google.com/books?id=Yq3VCQpK2KYC).

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Permalink Reply by D.D. on June 3, 2010 at 8:32am

Hey, thanks for the book reference - I'm going to order a copy today - my endo is the one who used this term brittle with me - I read part of the book preview and I seemed to fit - Last December I was almost hospitalized for adrenal exhaustion - I was close but got pulled back with cortisol tmt - I've been in the ER for almost 24 hours several times since Dec due to high bg that just shot up for no apparent reason and just wouldn't go down - they gave me lots of fluids - I've also had extreme bg from over 400 then down to 40 in 2 hours - what a ride that was - I've had lots of hypos lately - yesterday I saw my rheumatologist (he treats me for inflammatory arthritis and scleroderma (systemic sclerosis- a rare disorder and a cousin to lupus) anyway, he agreed with my endo (he didn't like the word "brittle") but said I fall into a "unique category" and he also thought I was a type 1) he said he will ask my endo to do the antibody tests - He printed out part of an abstract from his "UpToDate" subscription for docs on T1, so, that's the rest of my story - hope that helps fill in some of my background for you - I also have been treated for Grave's Ds (autoimmune thyroiditis) and my endo manages my thyroid supplement. Again, thanks for your feedback.

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Permalink Reply by Jag1 on June 3, 2010 at 2:12pm

You'll find that book is very expensive, but you can see a preview of it on the link given or on amazon.com. It does look like a good book if you're used to reading science papers - it seems to be aimed for physicians and not the general public.

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Permalink Reply by Brian (bsc) on June 3, 2010 at 2:57pm

Jag1 is right, the book is highly specialized, don't go and spend $200 on a book unless you really want it. You can read selected portions of it on books.google.com. If you then want to see it, look it up in a library. It should be available through many libraries through the common interlibrary loan program.

Trust me. I have serious book issues.

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Permalink Reply by Anna on June 3, 2010 at 2:18pm

Doctors frequently label people brittle. Basically, it means your blood sugars aren't perfect or even very good, and you have lots of highs and/or lows. I think it's just something they use (in the US) for insurance purposes, because people labeled as "brittle" can see the doctor more often or something. There have been other discussions on this, and we've all generally agreed there's no such things as brittle diabetes. However, I'd never heard of that study bsc posted; people with those issues probably deserve the term brittle.

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