In the 1940’s, when I was diagnosed, the term “brittle” diabetes was used to describe those diabetics who experienced dramatic swings in their blood sugar levels from low to high and high to low, throughout the day. The term “labile” is now being used by some doctors. I have also seen the term used in some posts on the diabetes websites.
I have an aquaintance, Mr Z, on another site who describes his labile diabetes. Mr Z is a wonderful author of many interesting posts/threads. I have learned so much from him. I have received his permission to quote him in the book I am writing. Mr Z has presented his own battle with labile diabetes. It is a rare thing to see him post about himself like this. I thought it might interest some of you to read his recent post.
Here is Mr Z’s description of his labile diabetes:
"I have had type 1 diabetes now for almost 43 years, and ever since the very beginning it has been totally uncontrollable. The problem is that the amount of insulin required to handle a meal eaten on Tuesday can be utterly inadquate to cover exactly the same meal on Wedenesday. The spontaneous variations in the amount of insulin required and the response of the blood sugar level to food and insulin taken are utterly unpredictable, so if I try to push the blood sugar level as close as possible to normal, all I do is guarantee that half the time the level will be far above normal and the other half of the time it will be far below normal. Just as a broken clock is right twice a day, so too a normal blood sugar level for me is just a value my blood sugar levels transit through twice a day as they skyrocket upwards or plummet downwards.
Since every time I take food and insulin just amounts to spinning the roulette wheel to determine what blood sugar value will be produced, the only way I have been able to approach even some minimal degree of stability has been to eat just once a day. In order to generate further stability, I eat exactly the same, well-balanced meal each day, and carefully measure every gram of food I consume. Since the glycemic index of food can vary according to subclinical food allergies in diabetics, I have found that 10 gm of strawberries can increase my blood sugar three times as much as 10 gm of raspberries, even though the two are in theory glycemically equivalent, so when I say I eat exactly the same meal, I don’t mean just the same number of calories of carbohydrates, proteins, and fats, but exactly the same food items, forever and always. I always struggle to get my blood sugar level to the same value before the day’s meal in order to stabilize results; I always eat at exactly the same time; and I always take exactly the same amount of insulin, unless I am correcting for some upward or downward trend in insulin requirements.
But even when I do this, I can wake up the next morning exactly the same number of hours after the meal with a blood sugar varying from 50 to 300! If I take a bolus of fast-acting insulin to lower the 300 result, the blood sugar can respond to being either 400 or 200 an hour later, depending on whether it is Tuesday or Wednesday, apparently, since I can assign no other cause to explain the difference. If the blood sugar falls into the low hypoglycemic range, the treatment required to bring me back to normal can range from a whole bowl of ice cream that has to be consumed immediately to a single ten gram slice of cheese. If I try to titrate the dose of calories taken to treat the hypoglycemic episode, I am likely to wind up in the emergency room of the local hospital, still clutching a half-eaten tube of glucose, totally comatose. Or I am just as likely to wind up with a blood sugar value of 500 as a result of having treated the hypoglycemic episode with exactly the same amount of glucose as proved totally insufficient the day before.
The worst problem of all is when I encounter some new endocrinologist, since they all love to play Blood Sugar Policeman, and they can only be Right and the patient can only be To Blame For Everything if blood sugar is in principle easily controllable, so endocrinologists fight like tigers to deny that the problems I have are real. After a while they give up and then we get along until I have to confront a new Dr. Idiot, M.D., and then I have to teach him all over again how uncontrollable the disease is by letting him see me in emergency two or three times unconscious as a result of his strict control abuse, after which he backs off.
I wonder how many other patients have to deal with this type of disease?"
Richard