Abstract
Salient aspects of prolonged metabolic studies on seven excessively labile diabetic patients and a review of the literature concerning causation and therapy of brittle diabetes are presented. Brittleness is redefined as “a syndrome of excessive insulin-sensitivity and ketosis-proneness manifested by extreme and unexplainable short-term and long-term fluctuations in the parameters of the disease”. Evidence on the causation of hyperlability points to dysfunction of plasma-protein transport and of hepatic and peripheral tissue metabolism of insulin. No objectively demonstrable complete and lasting stabilization was possible by means of any antidiabetic or adjunctive therapeutic measures. However, achievement of quantitative improvement in the accuracy of regulation of diabetes and moderation in deviations from the acceptable range of parameters were feasible. To this end, therapy recommended for everyday use incorporates the following principles found to be most helpful in following the oscillations of the disease on the research ward: flexibility in the plan of therapy; accuracy, especially in timing of therapeutic events; and employment of an insulin program best suited to the patient's needs and comfort.
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- BERSON S. A., YALOW R. S. Quantitative aspects of the reaction between insulin and insulin-binding antibody. J Clin Invest. 1959 Nov;38:1996–2016. doi: 10.1172/JCI103979. [DOI] [PMC free article] [PubMed] [Google Scholar]
- BUTTERFIELD W. J., HOLLING H. E. Peripheral glucose metabolism in fasting control subjects and diabetic patients. Clin Sci. 1959 May;18:147–174. [PubMed] [Google Scholar]
- COLWELL A. R. Treatment of diabetes selection of technic according to severity. Diabetes. 1953 Jul-Aug;2(4):262–267. doi: 10.2337/diab.2.4.262. [DOI] [PubMed] [Google Scholar]
- ELGEE N. J., WILLIAMS R. H., LEE N. D. Distribution and degradation studies with insulin I131. J Clin Invest. 1954 Sep;33(9):1252–1260. doi: 10.1172/JCI103000. [DOI] [PMC free article] [PubMed] [Google Scholar]
- ELRICK H., HLAD C. J., Jr, WITTEN T. A. Studies on the kinetics of glucose utilization. J Clin Invest. 1956 Oct;35(10):1139–1149. doi: 10.1172/JCI103368. [DOI] [PMC free article] [PubMed] [Google Scholar]
- HINKLE L. E., Jr, WOLF S. Importance of life stress in course and management of diabetes mellitus. J Am Med Assoc. 1952 Feb 16;148(7):513–520. doi: 10.1001/jama.1952.02930070013004. [DOI] [PubMed] [Google Scholar]
- JOINER C. L. Rate of clearance of insulin labelled with 131 I from the subcutaneous tissues in normal and diabetic subjects. Lancet. 1959 May 9;1(7080):964–967. doi: 10.1016/s0140-6736(59)91080-3. [DOI] [PubMed] [Google Scholar]
- MOLNAR G. D., GASTINEAU C. F., ROSEVEAR J. W., HELMHOLZ F. H., Jr, McGUCKIN W. F., CHENOWETH W. L. Metabolic effects of exercise and of multiple-dose insulin regimens in hyperlabile diabetes mellitus. Metabolism. 1963 Feb;12:157–163. [PubMed] [Google Scholar]
- MOLNAR G. D., MCGUCKIN W. F., STRIEBEL J. L., GASTINEAU C. F. Effects of therapeutic measures in a hyperlabile diabetic. Proc Staff Meet Mayo Clin. 1961 Feb 1;36:45–61. [PubMed] [Google Scholar]
- RIFKIN H. Clinical impact of insulin. Diabetes. 1963 Jan-Feb;12:31–37. doi: 10.2337/diab.12.1.31. [DOI] [PubMed] [Google Scholar]
- SELTZER H. S., SMITH W. L. Plasma insulin activity after glucose: an index of insulogenic reserve in normal and diabetic man. Diabetes. 1959 Nov-Dec;8:417–424. doi: 10.2337/diab.8.6.417. [DOI] [PubMed] [Google Scholar]
- WELSH G. W., 3rd, SIMS E. A. The mechanisms of renal glucosuria in pregnancy. Diabetes. 1960 Sep-Oct;9:363–369. doi: 10.2337/diab.9.5.363. [DOI] [PubMed] [Google Scholar]