保健 - 第23期 - page 30

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Yu Dai-zhang
DO Y()U KN(}W ABOUT THE
..BRITTLE DIABETES''?
The use of insulin is clearly
indicated in the youth-onset
diabetic, which is caused by in-
sulin deficiency and is called
IDDM (insulin dependent dia-
betes melitus). Occasionally, a
few of these IDDM patients are
difficult to control when they
are treated with insulin. They
are characterized by unex-
plained oscillation between
hypoglycemia and acidosis -
the so-called "brittle diabetes".
Knowledge of the nature of the
problem is limited. However,
development of circulating
antibody to insulin has been
suggested. The resistance
breaks abruptly and the patient
exhibits episodes of hypo-
glycemia as the antibody-
bound insulin is released and
becomes suddenly available.
However, the condition is
harmless if recognized and
treated early. Successful treat-
ment will depend upon the
thoroughness with which the
physician understands the par-
ticular problem in these cases,
upon how well the patient has
been instructed, and upon how
conscientious he is about follow-
ing instructions.
General advice should in-
clude avoidance of hypoglycemia
caused by unusual and excess-
ive physical activity or delayed
food intake. Parameters to be
monitored at regular intervals are
urine or blood sugars. For treat-
ment, it is best to start with crys-
talline insulin, which is best for
achievement of fast control. lt is
then employed for daily use in
combination with an intermediate
insulin to establish an adequate
control.
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