Brittle Diabetes Needs Patient Centered Treatment and Lifestyle Modification in the Rural

Abstract

The 'brittle' type 1 diabetes mellitus is characterized by severely fluctuating blood glucose levels, recurrent and long hospital admissions, and disruption of quality of life. When the case is brittle, it is more difficult to manage diabetes mellitus in the rural Turkey than in urban areas. We present a case of 33-year-old male patient with brittle type 1 diabetes mellitus for over 15 years. His life was a vicious cycle of episodes of hyper and hypoglycemia needing hospitalization approximately every 5 or 6 months for the regulation of his blood glucose levels. A family physician attributed the problem to stressful life circumstances. The patient has been divorced for many years, lost contact with his children and had difficulties in managing his life alone. A family physician counseled him using non-pharmacologic approaches. She arranged diet based on the patient's eating patterns, preferences, and metabolic goals. Macronutrient proportions were individualized. He learned carbohydrate counting and administered insulin for each meal based on the carbohydrate content. He quitted smoking. His socialization developed through psychiatric interventions. Despite lacking regular exercise, lifestyle modification helped the patient achieve more stable plasma glucose levels, avoid being 'brittle' and improve his quality of life in this rural context.