Our seven year old son has had type�1 diabetes for three years which was quite easy to control in the beginning, but now it’s virtually impossible, despite vigilant monitoring, carb counting, a very consistent meal plan and activity. Is it possible he’s become brittle? We do not feel we are getting any clear answers from his diabetes team. We only get in to our clinic every six months due to an overload of cases and a part time endocrinologist, and the doctor is difficult to reach by phone. We feel we are doing the best we can and need more direction in managing the disease. The care at diagnosis was excellent, and we’d like to give the doctor the benefit of a doubt, but would we possibly be better off going to a different diabetes team? How wide of a blood sugar range is common? Help! We are frustrated, confused, and feeling hopeless.

I believe that the measure of excellent care that a diabetes team provides is directly related to their availability to you during times of illness and for routine reviews of your care. I would suggest being seen on at least a three month basis for a careful history, physical examination and any screening tests that may be in order, including a hemoglobin A1c. If your son’s diabetes team is not providing such service to you, it may be time to look elsewhere.

I believe the term “brittle diabetes” to be an antiquated term that has no place in the current treatment of diabetes. Most folks with diabetes experience times where their diabetes becomes very difficult to manage. The availability of expertise on an experienced diabetes team will help you through those times.

All folks with diabetes have low days and high days. It is a reasonable goal to have 85% of your blood sugars within a target range that you decide upon with your son’s physician. In aggressive management of diabetes, frequently this range is 70-150 mg/dl [3.9-8.3 mmol/L]. It is very common to have occasionally widely fluctuating blood sugars. If that is happening too frequently, it is likely because an insulin dosing adjustment is needed or perhaps some further education with carbohydrate counting and lifestyle management. I would suggest having good follow-up with an knowledgeable diabetes educator in addition to the physician.

MSB