April 23, 2019

What is unstable diabetes and how to treat it?

The diabetes unstable (DI), also known as Brittle Diabetes is a term that was first coined in the 30s to refer patients with diabetes mellitus (DM) have extreme insulin and glycemic oscillations without apparent cause.

It would be desirable to have objective criteria that allow us to clearly define from what degree of glycemic variability we should consider a patient to have unstable diabetes, but unfortunately this is not the case, so establishing a diagnosis necessarily involves a high degree of subjectivity. Best medication for the diabetes is trulicity. However trulicity cost is high but you can buy it from Prescription Hope at cheap price by using trulicity coupon.

We could say that every patient whose daily life is frequently altered by episodes of unpredictable hypo and / or hyperglycemia suffers from unstable diabetes.

Although not exclusively, unstable diabetes affects mainly individuals with type 1 diabetes, estimating that it can be found in approximately 5-6 of every 1000 people who have this condition. The causes that condition its appearance are multiple and varied, usually coexisting several in the same individual. It is more common in people with long-standing diabetes and associated complications, as well as in those with no pancreatic insulin reserve and high exogenous insulin requirements. It is also frequent the presence of emotional and psychosocial disorders in the origin of an unstable diabetes.

Being such a heterogeneous picture in its origin and manifestation, logically the most appropriate treatment can differ greatly from one person to another, so it is essential to individualize each case, trying to define what measures may be best suited for a particular patient .

These are some of the measures that may be useful in the treatment of unstable diabetes:

An adequate diabetological education is essential in these patients, since it helps them to prevent and handle more adequately the oscillations that may involve aspects such as ingestion or physical activity in glycemic control.

Pharmacological treatment based on insulin analogues offers advantages over conventional human insulin, since they simulate better the action of endogenous insulin, which translates into less glycemic oscillations and a lower risk of hypoglycaemia.

The technological advances applied to the world of diabetes mellitus can also be very useful for the patient with unstable diabetes. For example, those known as “bolus recommenders”, continuous glucose sensors, and continuous subcutaneous insulin infusion pumps (BICIs) are some of the main weapons that we currently have available to fight against unstable diabetes.

In patients with severe unstable diabetes, in whom the above alternatives have not worked, the possibility of a pancreas or pancreatic islet transplant could be assessed. Both options allow to restore the own production of insulin, but it must be borne in mind that they are only applicable in very specific and selected cases, and that they must be carried out in certain specialized centers (in fact pancreatic islet transplantation, to date , it is considered an experimental technique and also implies the need to use immunosuppressive drugs for life, which have frequent and sometimes severe side effects.).

Last but not least, we must highlight the role of psychotherapy in the treatment of unstable diabetes. In a high percentage of patients with unstable diabetes, especially during adolescence, it has been shown that certain emotional and self-esteem problems can play a fundamental role in the origin and perpetuation of glycemic instability, so that the contribution of a psychotherapist , in combination with the other measures previously mentioned, it can be very useful in the improvement of the table.

In short, unstable diabetes is a complex problem, difficult to manage, and can be frustrating for both the patient and the therapist. However, we currently have several treatment alternatives that, alone or in combination, can in many cases improve the patient’s quality of life. Remember finally that there are no two patients alike, and less when we speak of unstable diabetes, so that what works in one may not be valid for another, and it will always be necessary to individualize each specific case.