Control strategy brittle diabetes.

Control strategy brittle diabetes.

Type 1 diabetes is an inherently unstable situation. However, long-term "brittle diabetes" reserves the instability of these cases, regardless of the cause, the result of the destruction of life and duration often recurrent and / or extended hospitalization. Affect three thousandths of patients with insulin-dependent diabetes mellitus, especially young women. Its poor prognosis patients with poor quality of life, more microvascular and pregnancy complications, shorten life. There are three ways: recurrent diabetic ketoacidosis, how great instability hypoglycemic and mixed. Fragility causes malabsorption include, certain drugs (such as alcohol, antipsychotics) defective insulin absorption or degradation of hyperglycemia glucocorticoid hormones, especially glucagon and defects, while the most important result of gastric emptying the autonomic neuropathy. The social and psychological factors are very important and human frailty can lead to self-sustaining conditions. Valuation changes of labile diabetes should quantify the level of blood sugar. In order to quantify the instability have been developed, including the maximum average amplitude glycemic excursions (MAGE), mean daily difference (MODD), the instability index (LI), low glycemic index (LBGI), Clark's achievements Hyposcore and continuous glucose monitoring. Psychological problems have been ruled out, treatment strategies need to manage potential organic causes brittle as long as possible, followed by the use of analogs of continuous subcutaneous insulin infusion and multiple injections, and consider the optimization of insulin therapy standard. The alternative method is the most severely affected patients still needed. Transplantation of isolated islets (IIT), recovery of the induction of glucose, hypoglycemia should consider the case of unconsciousness and / or unstable, especially if the body mass index <25, but patients with immunosuppression current program treatment must have normal renal function, it is best not intend to become pregnant. Implantable pump has an advantage, or weighing more than 80 kg or patients with hepatic or renal dysfunction, or very sensitive.