"BRITTLE" DIABETES

One of the most prominent features of diabetes is its uniqueness. No two diabetics respond in exactly the same way to food, insulin, or exercise, and no two individuals, even if they show the same test results, will suffer precisely the same ramifications. The disease is, by definition, unpredictable. Still, making allowance for surprises, we know the effects of more insulin, less insulin, more exercise, less exercise, more food, etc.

For most diabetics, most of the time, the "rules" work. "If I do this, or do not do that, I can expect this result." But there is a body of individuals for whom the rules do not appear to apply, and to them is often applied the adjective "brittle."

The problem becomes separating the truly "brittle" from the non-compliant and the poorly-controlled. Some authorities insist that if all diabetics diligently practiced "tight control" (as described by the DCCT), none would be "brittle." They're partially right; the numbers would go down, but some would remain.

There are some diabetics, practicing tight control, whose blood glucose level "over-reacts" to minute changes in diet, exercise, and/or insulin. These individuals experience unpredictable rises and swoops in blood glucose, within very short periods, as the result of very small departures from schedule. Small changes "break" their control, and they are thus said to be "brittle."

If you are practicing tight control, are in good compliance with your schedule, and are still experiencing rapid, out-of- proportion blood glucose changes, talk to your doctor. You may be "brittle," but your instabilities may be a sign of some other problem.