Clinical observation on brittle diabetes

Area of Science:

• Endocrinology
• Metabolic Disorders
• Diabetes Mellitus Research

Background:

• Brittle diabetes is characterized by unpredictable blood glucose fluctuations.
• Accurate quantification of glycemic variability is crucial for effective diabetes management.

Purpose of the Study:

• To quantify glycemic variability in severe diabetics using Mean Daily Difference (MDD).
• To investigate the relationship between glycemic variability, insulin requirements, and insulin resistance.
• To compare different insulin regimens for managing brittle diabetes.

Main Methods:

• Calculating MDD as the mean of daily blood glucose differences at four time points in 100 severe diabetics.
• Classifying patients as 'most brittle' based on MDD thresholds.
• Assessing insulin-binding capacity and total insulin in brittle versus stable diabetic patients.
• Comparing a stable insulin dosage with a sliding-scale regimen in two groups of brittle diabetics.
• Evaluating the effect of routine pre-meal insulin injections.
• Investigating intravenous insulin infusion in two brittle diabetics.

Main Results:

• MDD distribution was unimodal, with 15% of patients classified as most brittle (MDD > 100 mg/100 ml).
• No correlation was found between MDD and insulin requirement; brittle diabetics used 26-48 units/day.
• Insulin-resistant patients exhibited low MDD values.
• No significant differences in insulin-binding capacity or total insulin were observed between brittle and stable diabetic groups.
• Stable insulin dosage resulted in less glycemic variability compared to a sliding-scale regimen.
• Routine pre-meal insulin injections decreased mean diurnal glycemia but increased hypoglycemia.
• Intravenous insulin infusion stabilized blood glucose levels in two brittle diabetics, with meals causing only moderate hyperglycemia.

Conclusions:

• MDD is a useful metric for assessing glycemic variability in severe diabetes.
• Insulin resistance may be associated with lower glycemic variability.
• Stable insulin dosing regimens appear more effective in managing brittle diabetes than sliding-scale approaches.
• Intravenous insulin infusion offers a potential method for stabilizing blood glucose in severe brittle diabetes.