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Brittle diabetes Current Approach

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Dr. Srikanth

Veröffentlicht in: Gesundheit & Medizin
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Brittle diabetes Current Approach

  1. 1. CURRENT APPROACH BY Dr.SRIKANTH POST GRADUATE
  2. 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. 2
  3. 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. 3
  4. 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 4
  5. 5. • -Recurrent hypoglycemia • 1]Hypoadrenalism • 2]Hypothyroidism • Gastroparesis,celiac disease • Insulin autoimmune hypoglycemia • Post pancreatectomy surgery • Post chronic pancreatitis • Drugs[alcohol,antipsychotics] 5
  6. 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 6
  7. 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%} 7
  8. 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 8
  9. 9. Typical Diabetes Control • 12-18% in recurrent ketoacidosis • 4-6% in recurrent hypoglycemia 9 HbA1c levels
  10. 10. EVALUATION CONTROL • 2h Profile of glucose+insulin for 48h • Supervision of insulin injections • Psychosocial Assessment • Diabetes education • Screening for eating disorders 10
  11. 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. 11
  12. 12. MANAGEMENT Strategies in brittle diabetes ★ Qualification of glycemic variability ★ 1]MAGE ★ 2]MODD ★ 3]LI ★ 4]LBGI ★ 5]CBGM ★ 6]SMBG 12
  13. 13. TREATMENT options • Lifestyle and education • Psychotherapy • Alternative medicine • Insulin therapy • Insulin pump therapy • Islet transplantation 13
  14. 14. COMPLICATIONS • Gastroparesis • Severe malnutrtion • Endocarditis • Intracranial,retropharyngeal,pulmonary infections • pulmonary edema • Cerebral edema • Spontaneous muscle infraction 14
  15. 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 . 15
  16. 16. THANK YOU

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