No pattern here

No pattern here

Two weeks ago I met with my CDE, and we were of course discussing my blood sugar log. Yes for other reasons I have been keeping a detailed log of blood sugars and insulin dosed. She had two weeks of data, though she could have had 6 weeks if she wanted it. She did not.

She wanted to look at Basal and Bolus data, carbs consumed, and outcomes. She was careful to look at the standard; scientific approach to diabetic management, which is to look at before and after eating blood sugars, bolus and basal doses. Of course one factors in exercise, a little dose of random guesses and wham you have a scientifically informed treatment plan.

Well except, when you don’t. I don’t. Mine looks like a dart board, throw 15 darts a day and see where they land some are high, some low, some close, and a race car effect. Race car effect, yeah that is when you eat and you blood sugar takes off like a race car trying to get to the end of the track. My biggest issue is milk. When I drink it or drink milk like drinks my blood sugar goes haywire. It always does, and always has. I mean it is not news.

Anyway, so my blood sugar log is a mess. She looked at it up and down, down and up and decided to make some very minor basal changes and wished me well and sent me on my way. On my way out she said, you know I do not see a lot people with no pattern. You are one of those. I agreed and said if we could find a pattern I would love to change things so I could get some consistency.

Then I mentioned the word that is natural to me but was not too her. I said of course I am a brittle diabetic. She almost came off the chair. We no longer use the word brittle to describe diabetics with problem insulin patterns. Great I said what do we call them? I mean I want to know what I am. She said brittle means someone who cannot be controlled, she assured me I could be controlled. So I asked, how do I get controlled?

Well first she advised (tongue in cheek) I stop eating. Well that sounds reasonable, but of course I cannot stop eating? I mean I guess I could, but I would get well hungry? Right? Yes right she said. We could put you in the hospital and study the matter, she said. Why would we do that I asked, so we can straighten you out was the answer. Wait I am straightened out I said. Hmm well I asked what does the hospital have to do with living outside the hospital? Nothing really she said.

So what should I do. Well she said be careful. I am careful I thought. Well be more careful. Ok, I can be more careful I guess, careful of what I asked? Of what you eat she replied.

I said let’s face it I am a brittle diabetic right? Well I suppose if you put it that way yes you are. And therein lays the crux of the issue. For many years now I have been brittle. I battle diabetes, one meal, one dose, one hour of each day every day. Yes we can say there are no brittle diabetics. I do not want to be one. Never did, never will. But I am.

You can take away the label, you can say all diabetics are management issues, not body issues, but in the end when any scrap of food raises your blood sugar you are brittle. One can even call my type of diabetes complex, unresponsive, nonstandard, if that helps the medical community but for me I will always call it as I know it to be, I am a brittle diabetic.

Now I am not complaining or hiding behind a label. I get how tough management of a brittle diabetic is. I get that milk sends my blood sugar soaring, why? Who knows? But for goodness sakes let’s not call this a management issue just so we can feel better. Call it what it is and stop hiding behind the science of management or lack thereof. Yes I wish I fit in a box. I wish my diabetes made sense. But I also wish my doctor would pay me to come see him. I do not believe either wish will come true anytime soon. Brittle or not, managed or not, carbs in carbs out, insulin used, insulin saved. No I do not want to be brittle nor do I want diabetes. So look there are two things I don’t want.

So here I am brittle no more. I am now a management issue. Good grief. A management issue by any other name is brittle. I’ll take the name I was raised to understand. They, my CDE in particular can call it what makes her happy it is after all the same thing.




I see the pattern of non pattern issues. It is called random. So let's call you bg issues what is truly is…Randomness.

The term "brittle diabetic" fell out of favor because it was just a pejorative term "they" assigned to diabetics because they were too stuh stuh stupid to figure it out. So now they call it a "management issue". Still too stupid so instead of figuring it out they blame it on the patient. Typical.

I'm a patient at the VA in Phoenix and when I fired my Dr. the very first thing I my new Dr. flat out was "You guys can't normalize anybody's blood sugar because your feeding people too much carbohydrate." Consider the fact that a single gram of carbo will raise my blood sugar by 5 mg/dl. Then consider that "diabetes educator" of yours is probably telling you to eat 45 to 60 grams of bloody carbohydrate per meal. An uncovered glass of skim milk would raise my blood sugar by 75 mg/dl. If I dosed for 45 grams of carbo and I ate 60 I would end up too high by 75 mg/dl. If I dosed for 45 and ate 30 I'd end up too low by 75. Then "they'd" tell me to eat 15 grams of carb to correct the low and test 15 minutes later and if I was still too low eat another 15 grams. Of course my blood sugar would still be too low after 15 minutes because starches and most sugars don't even begin to raise blood sugar for 15 minutes and at the end of all of it I'd still be too high by 75 mg/dl. If my starting blood sugar was say 170 which according to them is safe at the end of it all my blood sugar would be about 250 or even higher because insulin resistance increases the higher blood sugar goes.

I'd say your diabetes educator is the one with "issues". If I were you I'd handle your management issues like Donald Trump and tell her "you're fired".

Rougediabetic: I actually grew up with the concept of brittle. To me it is not a pejorative term. It is a descriptive term. When I was a young man, I remember when my mom was first called a brittle diabetic. What it meant was she had to seek greater control through more urine testing and closer attention to food.

I guess to me it was a type of diabetes, I recall thinking there is type 1, type 2 and brittle type 1 or 2. So I really grew up with the term. It was descriptive, and not in any way a type of blame or a label that meant they were bad.

Mom was brittle and she lived like that for years. I have felt and called myself brittle for almost 20 years. I wear the label comfortably. So of course I can change, and labels are important. But so is my historic understanding of brittle. I wear the label in the same way I wear type 1. No I do not want to be brittle, or type 1 or even think of diabetes, yet I really have too.

Shoshana is absolutely correct it is a funny discussion. Calling my diabetes brittle or a management issue is absurd and funny. It is like calling a tree frog a bull frog. What I call it is of no consequence, it is what it is. My little interaction with the CDE (much of it tongue in check) was really a discussion of the comfort of labels.

I grew up using and I think people understand the term brittle. But if it is out of favor and thought by others to be pejorative, then ok. I just always term it what I know it to be, brittle. If I wear this label proudly for any reason it is because, it reminds me of my moms struggles. Yes I understand the term and its meaning and I know that it does not mean a bad diabetic, it means a diabetic who needs close management, no auto pilots here. Heck I would like auto pilot and when I was producing some natural insulin maybe 30 years ago auto pilot worked, today that is all gone. Today, I am brittle and the CDE can call it what she wants. I'll call it what I understand it to be until someone helps me understand why it is a pejorative term, until them I am what I am. Brittle.

roguediabetic i really like your answer.
rick i was never called brittle..........but i am.

Sounds like me. Every endo and CDE I've seen tries and fails to spot patterns. It does make me feel better, though, in that I know it's not just me doing something wrong. I think there are reasons for it, I just haven't discovered them yet, and/or they are my body responding in different ways to things out of my control.

Rick, the term "brittle" is still used, and I think appropriately. Every year my insurance company decides I should take Novolog rather than Apidra, and Lantus rather than Levemir. And annually, my PCP writes a letter saying that I have brittle diabetes that I can manage with Apidra and Levemir, but not with Novolog and Lantus. And of course, my doctor is correct. Lantus makes me sick, and Novolog--well, I just can't keep my blood sugars stable with Novolog, roller coaster here I come. I'd like to have lower A1C's, but doggone it, I'm brittle, and with the help of Apidra, I'm still alive and kickin'.