By Geoffrey Gill

Debatable when it comes to definition and administration, brittle diabetes is a tough quarter for many diebetologists. Bringing jointly the newest learn, volatile and Brittle Diabetes presents a finished evaluate that is helping the reader comprehend this complicated and problematic . themes comprise heritage of our wisdom of the sickness, an outline of the ailment, secondary motives, hypoglycaemic diabetic instability, insulin resistance and over-insulinisation, diabetic instability in young children and the aged, mental elements and intervention, instructing sufferers concerning the affliction, motives, results, remedy, tips on how to dwell with the sickness, and extra.

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Chronic overtreatment with insulin in children and adolescents. Am J Dis Childhood 1977; 131: 881–5. 30. Taylor R, Husband DJ, Marshall SM, Tunbridge WMG, Alberti KGMM. Adipocyte insulin binding and insulin sensitivity in ‘brittle’ diabetes. Diabetologia 1984; 27: 441–6. 31. Taylor R, Hetherington CS, Gill GV, Alberti KGMM. Changes in tissue insulin sensitivity in previously ‘brittle’ diabetes. Horm Metab Res 1986; 18: 493. 32. Gill GV, Williams G. Causes and management of poor metabolic control.

56. Strickland MII, Patam RC, Wales JK. Haemoglobin A1c concentrations in men and women with diabetes. Br Med J 1984; 289: 753. 57. Pound N, Sturrock NDC, Jeffcoate WJ. Age-related changes in glycated haemoglobin in patients with insulin-dependent diabetes mellitus. Diabet Med 1996; 13: 510–13. 58. Vince R, McGrath M, Trudinger P. Family stress and metabolic control in diabetes. Arch Dis Childhood 1996; 74: 418–22. 59. Ayres JG, Miles JF, Barnes PJ. Brittle asthma. Thorax 1998; 53: 315–21. 60. Gill GV, Williams G.

Information on 26 patients was available 10 years later. As well as examining mortality figures and causes, the patients and their hospitals were visited by a diabetes research nurse for structured quantitative and qualitative assessment. Their clinical, life quality and complication status was also compared in a case-control way, with a group of stable type 1 patients, matched for age, sex and diabetes duration. Of the 26 patients, 5 had died (19%) – only one from DKA (and largely due to lack of venous access).

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