The Brittle Battle

I think by definition of having Type 1, wide swings in blood sugar are fairly normal. EVERYTHING affects our BGs, so it makes sense that we can be sensitive one day to one thing, only to have everything change the next. And we all have those WTF? moments where you swear the number on the meter can’t be correct, and it’s just diabetes doing that unpredictable thing it does.

But lately, I’ve clocked some wicked fluctuations. Like double arrows pointing up after a not-so-carby meal followed by double arrows pointing down an hour later as I plummet low after bolusing. I’m quick to blame the odd schedule I’ve had for the past few months – irregular workouts, vacation travel, strange foods in unfamiliar places, lots of unknowns. But I’m back in my usual patterns this week, and still it seems my blood sugars are sensitive to everything right now.

Which got me thinking: can someone become more brittle the longer they’ve had diabetes? And then after I thought about that, I started to think about the term “brittle diabetes” in general. There’s  whole sections of the medical and diabetes communities that swear by this. The term “brittle diabetic” is used to describe a patient who is extremely sensitive to insulin, carbs, and other BG contributors. E.g. one unit can send them to a crazy low while a half unit leaves them high.

But there’s a whole other crew of both the medical and diabetes communites that think the term “brittle” is a bunch of BS. The rationalization is much like what I described above: everything affects this disease, so we’re all more and less sensitive to contributing factors at different times of the day, month, or our lives for that mattter. “Brittle,” those of that camp would argue, actually describes everyone with Type 1 since we’re all a bunch of hyper-sensitive folks by nature of having this disease. Some folks take the argument a step further saying that “brittle” is just code for “uncontrolled” diabetes.

When I look back on the times I’ve heard folks use this term, I have to admit it was often used to describe a person who, with a little more help, could actually get things more under control. Then again, going through this weird sensitivity issue I’m having right now seems like it has to have a name and a reason like “brittle,” because I can’t seem to root out a cause otherwise.

What’s your take on the concept of brittle? Is it just an excuse for the general ups and downs we all experience with Type 1? Or is it truly rooted in scientific evidence, and not just peanuts? (Get it? Peanut brittle…..Nevermind….)

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Brittle is just the medical community’s attempt to make sense of this (pea)nutty disease. I also think that the more you get plugged in to really working on doing well, the more opportunity you have to run into more WT… moments.

For example, I have noticed that when I exercise a lot, my body goes absolutely crazy when, for some reason, I don’t. Sometimes just ONE DAY of not exercising makes my BG go all over the place. Diabetes just happens. The most we can do is our best.

I have more highs then I have ever had before. I am not sure as we get older our body becomes more inefficient then it was before. I am not sure brittle is a word that I would discribe me. The blood sugars just do whatever they want sometimes. I was telling a coworker yesterday that I run without a test kit for 5 or 6 miles because it doesn’t really effect my blood sugar. Guess what, this morning I ran 8 miles and had my test kit and went low. I was a 121 and dropped to 67 22 minutes later. I should have not went low, but expect the unexpected.

Rather than repeating it here, I’d like to refer you to my post on the brittle topic from a few weeks ago:

My short answer to your question “What’s your take on the concept of brittle?” is: Ice cream.

Vera – HA! That’s interesting that WHO does indeed consider it to be a real term (although I like the ice cream expalnation better). But Tim and Todd, I hear you too – someetimes I think that’s just what it means to have this disease. We all have lots of ups and downs and unpredictability.

I always love to read your posts! I totally agree with what you are saying about the term “brittle”… my daughter who is 2 definitely seems to fit that definition, but every time I hear the word brittle it makes me cringe. Sometimes we go through these same episodes of double arrows up, followed by double arrows down- rocketing up and crashing back down. Nothing is more frustrating. Then, the next week with same meals and activity – stable numbers. I have often wondered if sensor placement has anything to do with it? Or pump site placement for that matter? Regardless a frustrating experience! I hope things settle down soon for you!

Jen, I’ve wondered the same thing – are there certain spots where absorption is more rapid, and certain spots where readings from my CGM are better than others? I’m not entirely sure but its so frustrating when you’re doing the see-saw thing of up and down and up again. Exhausting! But you are the real hero – being there for your daughter is nothing short of incredible. How lucky she is to have a mom like you!

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