The case of brittle diabetes: solution

The correct answer is choice number 4. The intern had looked at Leslie's legs.

Although erratic blood sugars with frequent highs and lows can be due to brittle diabetes that is seldom the case. Brittle diabetes is defined as diabetes with wide swings in sugar levels for no reason and leading to recurring hospital visits with either hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar). I virtually never see this. Much more often, erratic blood sugars are due to something that we can indeed put our finger on. Like non-compliance with therapy. Or bowel disease (like Celiac Disease or stomach emptying problems). Or, as was the case with Leslie, problems with the sites that are being used to inject the insulin.

What the intern saw on Leslie's legs were big bulges of fat called lipohypertrophy. These bulges are caused by the repeated injection of insulin into the same area. Insulin draws fat into the area and this causes unpredictable insulin absorption from these areas and hence, erratic blood sugars. The intern told Leslie to no longer inject into these areas and, lo and behold, within days Leslie's blood sugars were much better.

Click here if you want to learn more about lipohypertrophy.

By the way, this is the format I use in my book (What Your Doctor Really Thinks).

Old cases of the month can be found here.