Newman C, Dinneen S F
Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland.
Discipline of Medicine, NUI Galway, Galway, Ireland.
Diabet Med. 2020 Oct;37(10):1777-1780. doi: 10.1111/dme.13972. Epub 2019 May 2.
'Brittle diabetes' is frequently attributed to psychological stressors causing insulin omission in young women with Type 1 diabetes. It has received little attention in the recent medical literature.
We report the case of an 87-year-old woman who had recurrent episodes of unexplained diabetic ketoacidosis. Despite frequent inpatient monitoring of capillary glucose, her blood glucose levels remained erratic. She experienced a total of 12 episodes of ketoacidosis (some occurring during hospitalization), with 11 episodes occurring over a 3-month period. Several episodes of ketoacidosis required care in a high-dependency unit and up to 32 h of intravenous insulin and fluids. Extensive investigations failed to identify any underlying cause of the recurrent ketoacidosis. Ultimately, the introduction of a continuous subcutaneous insulin infusion pump resulted in improved glycaemic control and avoided the need for further hospitalizations.
Individuals of advanced age can benefit from insulin pump therapy. The original definition of 'brittle diabetes' referred to patients whose lives were 'constantly disrupted by episodes of hypo- or hyperglycaemia'. Our case reminds us that this clinical entity can result from altered biology and is not always related to psychological stressors.
“脆性糖尿病”常被认为是心理压力源导致1型糖尿病年轻女性胰岛素漏用所致。近期医学文献对此关注较少。
我们报告一例87岁女性，反复出现不明原因的糖尿病酮症酸中毒。尽管频繁住院监测指尖血糖，但其血糖水平仍不稳定。她共经历12次酮症酸中毒发作（部分发作于住院期间），其中11次发作发生在3个月内。几次酮症酸中毒发作需要在高依赖病房治疗，静脉输注胰岛素和补液长达32小时。广泛检查未能发现反复发生酮症酸中毒的任何潜在原因。最终，采用持续皮下胰岛素输注泵改善了血糖控制，避免了进一步住院治疗。
高龄个体可从胰岛素泵治疗中获益。“脆性糖尿病”最初的定义是指那些生活“经常因低血糖或高血糖发作而受到干扰”的患者。我们的病例提醒我们，这种临床实体可能由生物学改变导致，并不总是与心理压力源有关。
