Interaction of Endogenous Growth Hormone, Cortisol, and Catecholamines with Blood Glucose in Children with Brittle Diabetes Mellitus

Bruck, Erika; MacGillivray, Margaret H.

doi:10.1203/00006450-197506000-00005

Cited by 18 publications

(2 citation statements)

References 29 publications

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“…"Metabolic hypersensitivity" to catecholamines has also been suggested [32], but the failure of adrenergic blockade to modify the brittle state argues strongly against this hypothesis. Cortisol levels have not proved abnormal [55,56,57,58], and growth hormone levels have been reported as high [55,59], low [56], and unhelpful [57,58]. Low plasma glucagon levels were reported in one study [60] and may be important in some patients, but have not proved unusual in our own experience [58].…”

Section: Clinical and Metabolic Featuresmentioning

confidence: 77%

“…Endocrine abnormalities have been sought avidly over the years, but no pathognomonic changes have been found. Catecholamine hypersecretion has been suggested [32], but consistent abnormalities have not been found [55]. "Metabolic hypersensitivity" to catecholamines has also been suggested [32], but the failure of adrenergic blockade to modify the brittle state argues strongly against this hypothesis.…”

Section: Clinical and Metabolic Featuresmentioning

confidence: 99%

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Brittle diabetes — present concepts

1985

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Brittle" diabetes is one of the most poorly defined terms of modem medicine: it is emotive, subjective and imprecise. None the less it is an attractively appropriate descriptive term when clearly defined, and could usefully replace the many synonyms, such as "superlabile", "oscillatory" and "unstable". Woodyatt [1] was the first to describe patients with diabetes as "brittle". He defined such patients as "... insulin-dependent diabetics whose control is so fragile that they are subject to frequent and precipitous fluctuations between hyperglycaemia and insulin reactions and in whom causes of instability have been excluded." Used correctly this definition has proved useful although it has often been grossly abused. Rosenbloom [2], when discussing brittle diabetes in children, narrowed the definition to "those children whose sensitivity to insulin is such that a dosage change of 10% will result in either ketonaemia or reactions". Colwell [3] stated that "unstable diabetes is characterised by irregular, unpredictable behaviour of glycaemia and glycosuria with all insulins, especially the depot varieties, even though the food supply and amount of exercise are constant." These definitions, although useful, are rather restrictive and exclude those patients with predominantly hyperglycaemic or hypoglycaemic instability, which often form two distinct clinical subgroupings. In addition, it is now possible to define the cause of instability in many "brittle" patients (even if treatment remains difficult), and this would take many cases outside Woodyatt's definition. For these reasons, a more useful definition is that proposed by Tattersall in 1977 [4]... "insulindependent diabetics whose lives are constantly disrupted by episodes of hypo-or hyperglycaemia, whatever the cause". The concept of life disruption is an important one, which usefully separates problematic from non-problematic unstable diabetic patients.

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Section: Clinical and Metabolic Featuresmentioning

confidence: 77%

Section: Clinical and Metabolic Featuresmentioning

confidence: 99%

Brittle diabetes — present concepts

1985

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Clinical Observation on Brittle Diabetes

Lev-Ran¹

1978

Arch Intern Med

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Chronic Overtreatment With Insulin in Children and Adolescents

Rosenbloom¹

1977

Arch Pediatr Adolesc Med

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\s=b\ We have recorded clues to the clinical recognition of chronic insulin overdosage in 101 pediatric patients with diabetes mellitus, identified predisposing circumstances, and reconsidered the traditional strategy of slow reduction in insulin dose. Overtreatment occurred in 70%, overall, and in 90% of those referred for instability; mean overdose was 38% of the readjusted dose. The most common findings were frank hypoglycemic episodes, polyuria/nocturia/enuresis despite increasing insulin dosage, excessive appetite, hepatomegaly, weight gain, headaches, exercise intolerance, marked variation in glucosuria, mood swings, and frequent bouts of rapidly developing ketoacidosis. Overtreatment usually developed because of attempts to achieve metabolic control using glucosuria as principal criterion. One fourth of those observed became overtreated during periods of emotional turmoil when need for increased insulin to counter stressinduced hyperglycemia and ketosis led to chronic increase in dosage. Persistent glucosuria/ketonuria and exacerbation of hypoglycemic symptoms were more frequent with slow than with rapid reduction in insulin dosage.(Am J Dis Child 131: [881][882][883][884][885] 1977)

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Interaction of Endogenous Growth Hormone, Cortisol, and Catecholamines with Blood Glucose in Children with Brittle Diabetes Mellitus

Cited by 18 publications

References 29 publications

Brittle diabetes — present concepts

Brittle diabetes — present concepts

Clinical Observation on Brittle Diabetes

Chronic Overtreatment With Insulin in Children and Adolescents

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