Brittle diabetes: Strategies, diagnosis, and treatment

Schade, David S.

doi:10.1002/dmr.5610040405

Cited by 16 publications

(10 citation statements)

References 55 publications

(5 reference statements)

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“…3 Its treatment should be focused on resolving the underlying etiologies but unfortunately nearly half of patients respond to treatment of the underlying cause. 10 Biofeedback and hypnosis can use for treatments of this disease. 1 Treatment of comorbid psychiatric disorders are very important.…”

Section: Discussionmentioning

confidence: 99%

Recurrent diabetic ketoacidosis-like symptoms and factitious hyperglycemia as a Munchausen syndrome in diabetes mellitus type 1: a case report

Niafar¹,

Erensoy²,

Tekantapeh³

2017

Anadolu Psikiyatri Derg

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Factitious disorder is a psychologic problem which may cause symptoms of a disease which is non-compliance with patient physical exam. Some cases of brittle diabetes are because of underlying psychologic disorder such as factitious disorder or Munchausen syndrome. In this paper a 17-years old female is presented with factitious hyperglycemia and DKA-like symptoms such as nausea, vomiting and severe abdominal pain. Finally with subtle monitoring it was found that the cause of patient's hyperglycemia despite high dose insulin prescription was impregnating her finger into the date palm in the context of the factitious disorder. The patient had different deceptive behaviors depending on the method of treatment. She used every trick to mislead the medical team. In Munchausen syndrome, patient is unaware of his problem that mimic an episode of diabetic ketoacidosis. Thus psychotherapy is the main treatment of this factitious hyperglycemia. The main aim of this report is consideration of factitious hyperglycemia in patients with brittle diabetes mellitus.

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Section: Discussionmentioning

confidence: 99%

Recurrent diabetic ketoacidosis-like symptoms and factitious hyperglycemia as a Munchausen syndrome in diabetes mellitus type 1: a case report

Niafar¹,

Erensoy²,

Tekantapeh³

2017

Anadolu Psikiyatri Derg

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“…[32] When guideline implementation encourages treatment intensification, patients with “brittle” diabetes may have severe hypoglycemia even with a modest intensification of treatment. [33] Once these patients have an episode of severe hypoglycemia and are identified, they may be treated more liberally, and the rest of the population may be able to be treated more aggressively with fewer overall episodes of severe hypoglycemia.…”

Section: Discussionmentioning

confidence: 99%

The Risks and Benefits of Implementing Glycemic Control Guidelines in Frail Older Adults with Diabetes Mellitus

Lee

Boscardin

Cenzer

et al. 2011

J American Geriatrics Society

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BACKGROUND/OBJECTIVES To determine the hypo- and hyper-glycemic outcomes associated with implementing the American Geriatrics Society (AGS) guideline for Hemoglobin A1c (HbA1c)<8% in frail older patients with diabets. DESIGN/SETTING Guideline Implementation in PACE (Program of All-Inclusive Care for the Elderly) PARTICIPANTS All patients in the Before (10/02–12/04, n=338), Early (1/05–6/06, n=289) and Late phases of guideline implementation (7/06–12/08, n=385) with a diagnosis of diabetes mellitus and at least one HbA1c measurement. INTERVENTION Clinician education in 2005 with annual monitoring of the proportion of each clinician’s patients with diabetes with HbA1c<8%. MEASUREMENTS Hypoglycemia (Blood sugar or BS<50), hyperglycemia (BS>400) and severe hypoglycemia (Emergency room or ER visit for hypoglycemia) RESULTS Before, Early and Late groups were similar in mean age, race/ethnicity, comorbidity and functional dependency. Antihyperglycemic medication use increased with more patients using metformin (28% Before versus 42% Late, p<0.001) and insulin (23% Before versus 34% Late, p<0.001), with more patients achieving the AGS glycemic target of HbA1c<8% (74% Before versus 84% Late, p<0.001). Episodes of hyperglycemia (per 100 person-years) decreased dramatically (159 Before versus 46 Late, p<0.001) and episodes of hypoglycemia were unchanged (10.1 versus 9.3, p=0.50). Episodes of severe hypoglycemia were increased in the Early period (1.1 Before versus 2.9 Early, p=0.03). CONCLUSION Implementing the AGS glycemic control guideline for frail elders led to fewer hyperglycemic episodes, but more severe hypoglycemic episodes requiring ER visits in the Early implementation period. Future glycemic control guideline implementation efforts should be coupled with close monitoring for severe hypoglycemia in the early implementation period.

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“…There are reports in the literature in which no preventable factor precipitating hypoglycaemia could be identified in as many as 38-49% of the events [26][27]. Although alcohol consumption, excessive and unnecessary injections of insulin [28], sometimes with a suicidal purpose [29], may be more prevalent than previously thought, other reasons for unexplained, severe, hypoglycaemic attacks must be considered. The occurrence of severe hypoglycaemia has been related to long duration of the diabetic disease [30] which is in accordance with the present finding where the mean duration of diabetes was 30 years in the group of patients with severe hypoglycaemia.…”

Section: Discussionmentioning

confidence: 99%

The prevalence of impaired glucose counter-regulation during an insulin-infusion test in insulin-treated diabetic patients prone to severe hypoglycaemia

1989

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Among 603 patients over the age of 18, with insulin-treated diabetes mellitus, a questionnaire identified 98 patients who during a 12-month period had experienced severe hypoglycaemia, defined as an event which required the help of another person. Twenty of these patients had repeatedly suffered from such episodes, without any obvious reason, for a period of at least three years. The capacity to counter-regulate a standardized, insulin-infusion test (0.034 U.kg-1.h-1 given for 3 h unless severe neuroglucopenia developed) was evaluated in 14 of these patients. In 12, an impaired glucose counter-regulation was registered, defined as blood-glucose values below -2 SD of healthy subjects. In all but one of these patients, a combined deficiency of glucagon and adrenaline was documented, and was believed to be the likely cause of their inclination towards hypoglycaemia. In patients with severe hypoglycaemia, but not in diabetic patients without severe hypoglycaemia or in healthy subjects, a significant relationship between insulin disappearance and glucose rise was found. It is concluded that in insulin-treated diabetic patients, the prevalence of recurrent attacks of severe hypoglycaemia amounts to about 4%. In such patients, a combined deficiency of adrenaline and glucagon responses to hypoglycaemia is the predominant finding and the disappearance rate of insulin becomes critical for recovery of blood glucose after hypoglycaemia.

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Brittle diabetes: Strategies, diagnosis, and treatment

Cited by 16 publications

References 55 publications

Recurrent diabetic ketoacidosis-like symptoms and factitious hyperglycemia as a Munchausen syndrome in diabetes mellitus type 1: a case report

Recurrent diabetic ketoacidosis-like symptoms and factitious hyperglycemia as a Munchausen syndrome in diabetes mellitus type 1: a case report

The Risks and Benefits of Implementing Glycemic Control Guidelines in Frail Older Adults with Diabetes Mellitus

The prevalence of impaired glucose counter-regulation during an insulin-infusion test in insulin-treated diabetic patients prone to severe hypoglycaemia

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