Unstable and Brittle Diabetes (Advances in Diabetes)

Both sub-groups of diabetes mellitus - types 1 and 2 - are, for different reasons, difficult or impossible to adequately control. Diabetes health professionals regularly have to copromise ideal glycaemic aims against what can reasonably be achieved with the imperfiect tools of our trade, and the ever-present battle for patient-compliance. There are, however, extremes of control difficulty. In type 1 diabetes, such patients are frequently termed "brittle". They defy any semblance of metabolic control and are recurrently hospitalized with hyperglycaemia or hypoglycaemic crises. The very term "brittle" is shrouded in mystery as to its origin and in controversy as to its usefulness.This is the first book for nearly 20 years to deal with the problem of severely unstable diabetes. As well as brittle type 1 syndromes, the scope of instability has been extended to the notoriously problematic issue of obese and highly insulin-resistant type 2 diabetes, as well as instability in special groups such as the very young and the elderly. A multi-disciplinary and highly experienced group of writers have contributed, and there is even a final chapter by a patient. Issues of psychology, psychiatry and education are included, as well as more "medical" forms of management, such as insulin pump therapy and pancreas transplantation. Unstable and Brittle Diabetes provides a balanced view of this most difficult area of diabetes care. Editor Geoff Gill brings together the latest research on the management of brittle diabetes (or 'erratic glucose control'), which is a controversial area in terms of definition and management and one that creates much debate among diabetologists. This monograph aims to help the diabetologist understand this troublesome condition.