Anyone labeled "brittle diabetic" here? If so, what were your symptoms and what in the world causes it!?
I am LADA been on insulin 2 years and my A1Cs have gone from 5-6 to 7-9 in the past year even with increases in insulin and I never eat more than 20 carbs per day. I can go from 90-250 while fasting for no reason at any given time and take hours sometimes not even until the next day to come back into normal range. HELP!? #afraidofdiabeticdamage
yes, my endo told me i was brittle, but...every diabetic is 'brittle', IMO, so I dislike that term. You're not eating enough carbs, clearly. You do know that analog insulins were designed to work with carbs, not protein and not with starving yourself. so of course you can't eat anything, you've made yourself so carb sensitive. I've done the same thing too and am working on eating at least 60 carbs per day and more. I can eat carbs. it could be too that your basal isn't correct, it's taken up on the back or front end because you're not eating enough carbs..so, it can suck up the bolus. you're probably in constant rebound state because you're not even bolusing enough. also, too high of a basal can have the reverse effect and push your numbers up. why don't you start eating, at least 15 carbs per meal, try 20, prebolus 25 minutes, if you're not low and eat.
You keep doing the same thing, it seems, not eating - starving yourself with no carbs, heavy workouts, etc..to get your BG's down, adding more insulin and your numbers are going up. Maybe it's time to try something 'new'..and I'm concerned this is going into an eating disorder pattern...i hope that's not the case (i've been there, too). If you look/read the comments on here from successfully pumpers who have good (even great) A1C's, are healthy, etc...AR, Zoe, many many more, they EAT carbs. Every type 1 I know it's carbs...please try something else. Unless and until there is a cure, you've got a long way to go with this, ya know. What you're doing is not working. :)
That is way too little of carbs a day. Try doubling that a day at the least if not more.
As Sarah summarised, There is no such thing as a brittle diabetic. That is really just a term to indicate poor Blood Glucose management by someone who is not a PWD and doesn't know any better.
I think you have two issues going on here.
1. As a LADA you will have been experiencing a honeymoon period where your beta cells have still been producing a trickle of insulin. That honeymoon is likely to be over and no more insulin is being produced. As a result you probably need to increase your basal dose.
2. Your basal dose is insufficient to meet your daily needs. The best way to treat this is to do a 24hr fast, only inject your basal dose and test your BG every 2 hours to see if it stays stable. If it does you are good, if it doesn't then you need to increase your basal dose by 1 to 2 units, wait 3 days and then repeat the procedure.
Lastly if you are on a low carb diet you need to make sure you are eating sufficient natural fats ( eg., butter, cream, lard, dripping or cocunut oil.) to provide a balance. If you go low carb low fat you are basically starving yourself and in starvation mode your body does strange things. Google LCHF Diets for some ideas.
Hope that is not too over the top for you.
Cheers,
Bruce
Historically, the term brittle diabetic was given to patients that just didn't do much of anything to manage their diabetes. Don't ever take that as applying to you, especially if you are trying to do all the right things to manage your diabetes. Sometimes, stuff just happens. You may well be very sensitive to carbs and you may have a highly variable response to your insulin. And you may have a stressful life. Please remind yourself, that if you are doing everything you possibly could do to maintain tight blood sugar control, you should never look in the mirror and feel a sense of failure, instead you should look at a hero, one who persevered in the face of adversity.
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Hey guys, there is no such thing as "too little" or "too many" carbs. We are all different. Many people on here do very well with Bernstein level carbs (30 per day) others eat lowish to moderate carbs and some eat more. It is really the propaganda of the medical profession that we need lots of carbs. Please don't characterize me as someone who who "EATS carbs". I work very hard to stay as low as possible: always under 100, preferably under 50 when that is possible for me. If I eat more than that I gain weight, so I do what works FOR ME. As a vegetarian and a foodie there is a limit to how low I can/want to go but I do not push carbs...hardly. Again, we are all different.
I agree with the others that "brittle diabetic" is an outdated term...and a judgmental one. LilMama, we've watched you evolve since you came on here and you work very hard at your management. I agree that you are probably coming out of your honeymoon period and you need to look at making some changes to put your insulin dosing in line with your needs. Do you have someone you can work with to help you adjust doses? If not, do let us know more about the specifics of your dosing and we can make suggestions. Start with your basal and see if you can get things more in line to meet your needs. Don't give up hope, things change and you can change with it!
people can do and eat whatever they feel comfortable with, it's our own individual disease. However, this poster is looking for suggestions. I strongly disagree, eating 20 carbs or less is basically starvation -it's basically no more then 2 cups of vegetables or 1 c. + 1 glass of milk, that's a far cry from the ADA's recommendations or even 50 grams per day. I believe this poster mentioned she weighed 100 lbs. so clearly weight loss isn't an issue. Our bodies don't work like non-diabetics, we can't trick it into doing things it doesn't want to do. We do need carbs or we'll end up having to bolus for everything (as I've stated over and over), including protein. So, what's the point of low carbing, if the goal is to lower insulin doses, IMO.
A brittle diabetic never meant someone who didn't take care of themselves or their diabetes, that's not at all where the term was generated from. Additionally, if one is already ketonic from such low carbing and having high blood sugars in the 250's and throwing high BG ketones, that's a disaster..there's also liver dumps from not eating. A type 1 diabetic's body is very completed and we need to do the best to and for it.
Hi Lil MaMa: I concur with Brian, "brittle diabetes" just does not describe you. You always take good care of yourself! But your profile says that you still take shots--is that true and have you considered an insulin pump? A pump can give you the basal rate that you truly need. If you do the appropriate basal testing with a pump (I did my basal testing with guidance from John Walsh's "Pumping Insulin") you can really manage so much better. I use an Animas pump and the Dexcom continuous glucose monitor. Things to consider?
LilMaMa, Happy Birthday !! Here is hoping your day is full of joy and happiness.
Everyone is speaking to your insulin regimen, but you have not told us what it is, at least in this post. I also looked at your other posts and noticed that as far back as 2010, replies have noted too few carbs/too much exercise as the problem, but it does not seem to be changing.
If you are consistently bouncing around with numbers like that, something requires a change. And remember, if you get to a place where you can actually stabilize your glucose numbers, you will feel SOOO much better. Also, remember that the change will take time.
And I always knew brittle diabetic as a term used in the days when there were few options for treating diabetes. If the normal process was not controlling glucose levels, you were brittle. Because of all the new options, the term is really not relevant anymore.
Wow what wonderful responses and things I never thought of. I had raised my carbs to about 80 a day beginning in October and gained 10 pounds very quickly and my A1C went up to 7.8. I have in the past two months began going "low carb" again because I hated the blood sugar roller coaster that eating carbs put me on. However I am now going from 100-200+ just from chicken, eggs, salad without dressing!? Its so frustrating. My dr pretty much says I'm a
"special case" and just very carb sensitive. I currently take 13 units of basal a day, weigh 110 lbs, workout daily, and am on Humalog on a minimed insulin pump.
I can take bolus after bolus but once my blood sugar gets over 200 it doesn't usually come back down until the next morning :(
I was labeled as "brittle" by my doc once for totally different reasons. I was eating a lot of carbs and taking tons of insulin. At the time, I didn't understand why my BG was all over the place. Now, I understand it was because of my mismanagement.
I know someone who's condition is similar to what you are describing, and there are other members here who are very insulin sensitive, which I believe can make things difficult.
I've found that on a LC diet, I have gradually become quite sensitive to protein. Bolusing for protein accounts for about 50% of my insulin needs, now.
As previous posters mentioned, make sure you are not starving.
Sometimes your metabolism and insulin requirements seem to shift for no apparent reason. Not fair, but that's diabetes for you.
as I said, you're going to have to bolus for everything, protein, etc...LilMama, i've been through this, everything raised my blood sugars. My endo spent a lot of time explaining this to me, body soon converts everything into glucose because there are not enough carbs and the analog short acting insulins work on carbs. try less carbs, maybe 60 per day and add back slowly..as you mentioned you're eating carbs, not eating carbs and your BG's are still going up. so, it's not really the 'food'. yes, you'll probably gain weight but you may be gaining weight because your insulin doses aren't right. I'll gain weight if my blood sugars are high (not high enough to be DKA and losing weight) and I'm not taking the right amount of insulin, i.e., it's just sitting there in my body creating insulin resistance, in a sense. as soon as I get my numbers down, using the 'correct' amount of insulin for my body, it goes away, it's mostly 'water', water retention. Try some basal testing, are you waking up to good numbers, what is your I:CR?
Maybe try a different fast acting, novolog, apidra, if you haven't already. Did your endo have any suggestions? Yes, when we're high like this, it takes a long time to come down and this can also mean your basal isn't right. Could it be your sites/sets? Are you prebolousing? Are you doing manual corrections when BG's are high? I can shoot tons of insulin but if my basal isn't right (still working on my levels, too) it might budge for a bit but goes right back up. Basal is our foundation, nothing works if it's off. Hope this helps a bit? :)
a few more things; do you have your basal rates set correctly? do you have a CGM? if not, maybe your endo can put you on a trial CGM, it's blind, but it would give you (him/her) a better understanding of what's going on? maybe you're having rebound highs? if you can get a CGM and want one, it's really a very insightful and valuable tool. just a thought?
Hi LiL MaMa: I am glad you are on an insulin pump! Have you done the basal testing to really get your basals right? I find that if my basal rates are correct, I avoid most highs. And most women need to have a separate basal setting for just before their monthly cycle, when you become more insulin resistant. Also, I agree with Sarah, a CGM might be really useful.
If for some reason I do go high, I often will do an injection instead of using the pump to bring me down. It works faster for me. Just a thought.
I've never heard "brittle diabetes" defined as a person who is non-compliant or not trying hard enough. I understood it to mean someone who has rapid changes in blood sugars, like a drop of 100 mg/dl in half an hour, or frequent lows. I was always referred to as brittle, but I thought it was an old fashioned term used before the days of BG self testing & that it was no longer used by the medical profession.
I would wonder about doctor tossing around a label like "brittle" as I think the term is obsolete and kind of frowned upon, although someone (Holger perhaps?) had mentioned that in Germany the term is still in use. I had thought it referred to a situation where the person was having a lot of fluctuation in their BG numbers. Whenever I've had periods where that was the case, I've been able to say "hmm, something is off, let's see where it is" and then to look at data to see that say I'm running low every night after dinner and waking up high from over treating or running high after breakfast regularly and make an adjustment to my doses.
I don't think that it's appropriate for a doctor to label you "brittle" if he hasn't made enough suggestions about how to fix it. That's a copout to me and would make me think they are a crappy doctor. When I had my A1C "bubble" c. 2007, my doc knew what I was doing (working out hard 5-6 days/ week, guessing numbers...) but didn't label me "brittle", he said "you need to be on modern insulin" [instead of R/NPH] and, with the help of my friend's wife, decided to try a pump and keeping track of things. I don't totally do low carb eating (it seems 100-140G/ day...) but eat pretty lightly during the day and I find that eating very similar food a lot makes it easier to see when changes need to be made. If the doc can't figure them out, maybe try a new one or post more clearly what sort of numbers you are seeing and we can try to suggest how to think of adjustments?