2. INTRODUCTION
• Almost all diabetic patients experience swings in
blood glucose levels ,which are larger and less
predictable than in non diabetics.
• When these swings become intolerable and cause
distruption to person daily life the person is able to
have brittle diabetes.
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3. HISTORY
• In 1942 the chicago physician Woodyatt introduced
concept of brittle diabetes.
• In 1950s the question was whether they were two
Distinct group of patients.
• In 1977 Tattersall defined brittle diabetes as
patients who”s life was constantly disturpted by
episode of hypo- or hyperglycemia
• In 1980 group investigation.
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4. ETIOLOGY
• Psychological[most comon]
• Nonphysiologic matching of meals,exercise and insulin
• Poor adherence /compliance to treatment
• Chronic infections
• Chronic medical illness
• Endocrinopathies
• -Recurrent Ketoacidosis
✦ 1]Acromegaly
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5. • -Recurrent hypoglycemia
• 1]Hypoadrenalism
• 2]Hypothyroidism
• Gastroparesis,celiac disease
• Insulin autoimmune hypoglycemia
• Post pancreatectomy surgery
• Post chronic pancreatitis
• Drugs[alcohol,antipsychotics]
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6. Rare causes
• Mauriac syndrome:It is rare complication of type 1
DM characterized by extreme hepatomegaly due to
glycogen deposition,along with growth failure and
delayed puberty.
• Polyglandular autoimmune syndrome
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7. CLINICAL
MANIFESTATIONS
✤ Three clinical forms of brittle diabetes have been
describe
• 1]Predominant hyperglycemia with recurrent
ketoacidosis{59%}
• 2]Predominant hypoglycemia{17%}
• 3]Mixed hyper-hypo glycemia{24%}
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8. History and Examination
• Pubertal status in Children
• Features of Mauriac Syndrome
• Features of Endocrinopathies
• Signs of chronic infection
• Cutaneous manifestations
• Drug history
• Diabetes Knowledge
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9. Typical Diabetes Control
• 12-18% in recurrent ketoacidosis
• 4-6% in recurrent hypoglycemia
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HbA1c levels
10. EVALUATION
CONTROL
• 2h Profile of glucose+insulin for 48h
• Supervision of insulin injections
• Psychosocial Assessment
• Diabetes education
• Screening for eating disorders
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11. IF INDICATED
• Gastric emptying tests
• Insulin &Insulin Receptors Antibodies
• Screening for drugs or Abuse
• Insulin Challenge Test:0.1 U/Kg injected SC or IV
and comparision of insulin&glucose profiles with
normal ranges.
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15. SUMMARY
• Severely unstable,or brittle, diabetes can be
disruptive to patients
• The peak age group of brittle diabetes is 15-30.
• In younger patients the principal manifestation
brittle diabetes is recurrent ketoacidosis.
• In elderly the manifestation is recurrent
hypoglycaemia .
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