Managing diabetes: challenging or impossible?

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Volatile blood-sugar swings should be checked by a specialist

“Living with type 1 diabetes (T1D) has physical, emotional and psychological challenges. People with the disease must carefully balance insulin doses with food consumption and physical activity. They must measure their blood glucose by pricking their fingers for blood six or more times a day and also cope with the constant worry and attention that diabetes requires. Even with all of these efforts, people with T1D must also accept that every day something will not go as planned. Living with diabetes is dangerous! People with T1D run the risk of high or low blood-glucose levels daily, both of which can be life threatening. This disease is terrifying for families, loved ones and individuals living with T1D.” – Nicole Johnson, Dr.P.H., M.P.H., M.A., a member of the JDRF International Board of Directors and Miss America 1999

Managing diabetes is tough for everyone. But for some people it is especially hard. No matter how diligently they care for themselves, their blood-sugar levels change erratically, spiking high enough to cause ketoacidosis or plunging dangerously low with little warning. The rapid and unpredictable blood-sugar fluctuations are so extreme they interrupt regular daily activities and increase risk for debilitating complications and acute medical emergencies. When the challenge of managing diabetes becomes an impossible one, it can be a sign that there are other health issues that need to be addressed. This is sometimes called brittle diabetes.

In brittle diabetes, many factors may contribute to turbulence in blood-glucose levels, according to the Genetic and Rare Diseases Information Center of the National Institutes of Health. Conditions that can cause trouble include stress, gastroparesis, and even other autoimmune disorders like celiac disease and thyroid disorders that occur more commonly in people with T1D. If the underlying problems are identified and treated, then blood-glucose levels may settle into a more regular and predictable pattern, making diabetes somewhat easier to manage. People experiencing wild variability in blood sugar should consult an endocrinology specialist to help detect potential causes. “Endocrinologists are trained to look for factors that can lead to unstable blood-glucose readings,” according to Steven Griffen, M.D., JDRF Senior Vice President of Research and an endocrinologist himself. The endocrinologist can then work with other members of the healthcare team to develop an appropriate management plan.

Why It Matters

Unpredictability sometimes comes with the diabetes territory, but extreme variations in blood sugar may have specific root causes that can be treated to improve manageability.

Learn More

Find out more about brittle diabetes from the Genetic and Rare Diseases Information Center of the National Institutes of Health, or learn how to assemble a healthcare team on JDRF’s social network