My wife has had type 1 diabetes for about 20 years, and she told me it was brittle diabetes. She is having great difficulty in regulating her levels. In am she is averaging about 200 mg/dl [11.1 mmol/L] in the morning and 400 mg/dl [22.2 mmol/L] (or much more — off the scale some days) in the evening. She has increased her insulin with variable results — either no effect or severe bottoming out. Our free clinic has her monitoring and adjusting her own insulin, but it is continuing to get worse.

This is a common situation. The term brittle is descriptive. In my mind, it refers to blood sugars with a great deal of variability. Unfortunately, research has told us that the brittle diabetes issue is largely patient-centered. This means that there are a number of issues which need to be addressed by your wife’s diabetes team. The issues include such things as daily schedule, exercise, meal content, complexity of insulin regimen, mechanisms for daily adjustments, insulin injections sites and status, insulin preparations, care of the insulin between periods of use, and other medical problems. My advice is to find someone who can spend time with her so that these issues can be worked through. It will not be fast or easy but it is definitely worth it.

JTL