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Question
My dad has just discovered he has a tumour on his pancreas, and it has to
be removed which will leave him with brittle diabetes.
What is the mortality rate of people suffering from this? What type of quality of life do they have?
Answers
My best wishes for your father's speedy recovery.
Brittle diabetes
is not a distinct entity, and thus I
do not believe there is more change in diabetes-related death rates from having one's pancreas
removed vs. having long-standing
type 1 diabetes
from the usual
autoimmune
cause. When people refer to having "brittle diabetes" they are implying that there are many, many wide
fluctuations in
blood glucose
from very, high to extremely low. Often those patients who claim they have "brittle" diabetes actually just have poorly controlled diabetes because they
are not properly matching meal planning, physical activity, and insulin dosing. With proper education, typically with a
recognized diabetes education program, and genuine
attention to meal planning, I would not expect super-wide fluctuations.
Now that is not to say that a person with diabetes never has
glucose fluctuation, could never have a serious
low glucose level or could never have serious high
levels that progress to
diabetic ketoacidosis.
But recurrent "unexplained" highs and lows should not typically occur
with attention to those issues relayed above.
So I would tend to have you shy away from any
concept of "brittle" diabetes and focus on the important issues of diabetes education, meal planning,
regular activity, and insulin dosing. The newer insulin regimens of dosing
insulin in a "basal-bolus" manner, whereby a low level, background
insulin (the "basal"
insulin) is given in conjunction with extra insulin with
doses based on food consumption (the "bolus" dose)
can help minimize
wide, frequent glucose fluctuations.
ids
Prevalence and Incidence of
Secondary and Other Types
of Diabetes
is a chapter in an endocrine textbook,
at the National Insitutes of Health - National Institute of
Diabetes, Digestive and Kidney Disorders
website,
and it is quite "technical." However, it is informative and may
be able to answer some of your questions.
[http://diabetes.niddk.nih.gov/dm/pubs/america/pdf/chapter5.pdf
(PDF file)].
slb
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