Management of patients with 'Brittle' Diabetes has to be individualized (depending on the specific cause in each case). Most patients with brittle diabetes have mountainous medical records. Hence it is beneficial to start fresh---possibly with a new doctor and diabetes care team. This helps to give a fresh look to the case and is helpful in remaining objective. Your doctor will take a detailed history and do a thorough physical examination. Your doctor will try to establish if there was a period of "stable" diabetes before the brittleness started and if there was a specific factor or reason that is coincident with the onset of brittleness.
Diabetic education is important in people with brittle diabetes. Your doctor will evaluate whether you knows how to manage your insulin needs and whether the current insulin regimen is reasonable.
Many people with brittle diabetes have been found to have a "communication disorder." And this has been determined as the major cause of their brittleness----specific treatment for communication problem has been noted to be beneficial in them (about 75% of cases). Your doctor may recommend psychological evaluation. Psychotherapy has been noted to be effective in some patients. In addition family counseling is also recommended as many patients benefit from it.
People with severe brittle diabetes may need hospital admission for detailed examination and testing. Initially the doctor and the hospital team will take care of your blood sugar and insulin. But gradually, you will be involved more in your diabetes care (blood sugar level monitoring and insulin administration). You will be given intensive diabetes education, psychological support and family counseling as recommended.
Dr Poonam Sachdeva, our in-house medical expert talks about the why what and how in diabetes.
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