Brittle Diabetes Mellitus (BDM)

General Purpose

To inform the audience about the condition, Brittle Diabetes Mellitus Specific

Purpose

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To provide information on (1) the condition’s factual descriptions and (2) impact to a person’s life Central Idea: The presentation centers on the general description of Diabetes Mellitus, then proceeds in elaborating the actual condition of BDM. Factual description, signs and symptoms, related medical interventions, incidence and the impact of the disease to an individual are the focal points of this presentation.

Introduction

Attention Strategy

The presentation shall utilize persuasive and factual illustrations of the case to obtain the necessary attention from the audience. The study utilizes an evidenced-based analysis to further the discussion and obtain the attention of the general audience. In addition, it employs real life basis from the medical case of Cathy who died due to severe complications of BDM.

Revelation of Topic

The study reveals the danger and complexities of the rare type of diabetes, which is BDM.

During BDM presentation, the principal revelations include (1) the specific case of BDM and its difference from the typical DM Type 1/Type 2, (2) the increased chances of diabetic complications in BDM than the common DM cases, and (3) medical history of individual who have suffered the case of BDM.

Credibility

The credibility of the presentation lies with countless hours of research, references from credible authors and scholarly literatures, academic background on EMT-B, CNA and being a paramedic student, and an experience from an Aunt who died from BDM complications.

Discussion

Diabetes Mellitus (DM) is a clinical syndrome characterized by the deficiency or insensitivity of the body to insulin, and exposure of organs to chronic hyperglycemia is the most common medical complication of the disease (DeCherney and Nathan, 2002 p. 326). There are three known types of DM, namely (1) Type-1 or Insulin-Dependent DM (IDDM), (2) Type-2 or Non-insulin-Dependent DM (NDDM), and (3) Gestational DM (GDM). According to Marso and Stern (2003), these three types of DM are all characterized by the increased sugar levels in the blood (hyperglycemia); however, these are differentiated by their nature of occurrence and etiology.

Type-1 occurs due to the genetically impaired insulin receptor that prevents the insulin from binding to these receptors that provide the necessary signal for glucose cellular absorption. Type 2 occurs as a product of acquired metabolic impairment, particularly obesity, that also impairs the binding between insulin and cellular receptors due to the extensive distribution of fats. Lastly, GDM occurs during pregnancy as a product of bodily modification, specifically carbohydrate intolerance, on the pregnant mother’s body (Montella, Keely and Lee, 2008 p. 216).

These three types of DM are the most commonly known cases; however, a rare type of DM, known as GDM, also occurs to few people. According to Gill (2004), the case of GDM is similar to the manifestations of Type-1 DM although, with increased severity and frequency of occurrence (p. 11). Woodyatt in 1934 uses the term “brittle” to describe the main characteristic of the disease, which is the oscillation or instantaneous variations of glucose levels. According to mortality rates, the highest prone group is between 25 to 64 years (45%), followed by 65 to 74 age group (22%) and the youngest group of 16 to 44 (16.7%).

Patients experiencing this rare DM condition can experience multiple types of severe symptoms, specifically (1) ketoacidosis, (2) hypoglycemia, and (3) hyperglycemia. In the case of BDM, the occurrence of hyperglycemia and/or hypoglycemia can be very sudden and extreme in levels, which consequently makes diagnosis almost impossible due to the unpredictability of its manifestations. Ketoacidosis occurs during an extreme drop of insulin levels in the body that consequently increases blood sugar contents in the body making it thick in consistency (Backer, 2005 p. 201).

In addition, ketoacidosis occurs in a very unstable levels and unpredictable frequency. BDM can be very hard to control due to the severe swings on blood sugar levels. Medical practitioners commonly advice exercise, careful monitoring of diet and blood glucose levels at least every 30 minutes for the first 5 hours of BDM manifestations (Ballanoff, Yu and Stjernholm, 2004 p. 132). Signs and symptoms that need to be carefully monitored are fruity breath, dehydration, increased thirst, severe and instantaneous weight loss due to muscle wasting and increased frequency of urination (polyuria).

Meanwhile, severe complications that can result include (1) kidney damage due to nephropathy, (2) hypertension and heart damages (e. g. Cardiomegaly, Cardiac arrest, etc. ), (3) eye damage (e. g. glaucoma, cataracts, retinopathy, etc. ), (4) diabetic neuropathy affecting nerve functioning that eventually leads to leg and feet necrosis, GI peristaltic-related indigestion and impotence (erectile dysfunction), and (5) series of life-threatening conditions, such as hyperlipidemia, atherosclerosis and diabetic coma (Ballanoff, Yu and Stjernholm, 2004 p. 132-133).

One of the historically recognized records of BDM case is Cathy who was born in September 21, 1961 and eventually diagnosed with type 2 DM at the age of 20. Despite of different medical opinions and treatments on controlling her sugar levels, her blood sugar had continued to oscillate. In 1999, she had her child named, Sam, but her body rejected the baby during pregnancy due to severe diabetic complications. Things started going bad in the year 2000 as she was diagnosed with stroke and developed severe neuropathy on her feet.

As the years passed by, she had experienced BDM complications, such as heart attack in 2002, leg venous blockage in 2003 that eventually ended in surgery, and complete irreversible neck vein blockage in 2005. In 2007, Cathy had a stroke that destroyed almost all parts of her brain except for the remaining quarter piece of her brainstem. She lived for three days after the incident, and on May 22, 2007, Cathy’s body finally gave from the complications of BDM.

Conclusion

In conclusion, BDM is indeed a rare but tremendously life-threatening condition. Considering the standard DM treatments available, Diagnosis and treatment are both hard to administer due to the unpredictable and extreme drops or the rise of blood sugar in the body. The most common manifestations of BDM include severe hyperglycemia, hypoglycemia, and ketoacidosis. If these conditions pursue, minor complications, such as polyuria, dehydration, thirstiness, etc, can lead to more severe conditions, such as hypertension, heart problems, diabetic coma, etc.

To avoid these complications, medical experts had to suggest frequent blood sugar monitoring, diet restrictions, and exercise. One of the recorded cases of severe BDM is the progressive diabetic complications of Cathy. She first developed Type 2 DM indications at the age of 20. The doctors diagnosed her condition as BDM due to unpredictable and extreme rise of blood glucose levels. She was able to live a life of a common DM patient until she failed pregnancy in 2000, which eventually developed into severe BDM complications.

She died on May 22, 2007 due to the massive stroke that nearly damaged her entire brain.

References

1. Backer, H. D. (2005). Wilderness First Aid: Emergency Care for Remote Locations. New York, U. S. A: Jones & Bartlett Publishers. Ballonoff, L. , Yu, W. , & Stjernholm, M. (2004).
2. What to Do When the Doctor Says It's Diabetes: The Most Important Things You Need to Know about Blood Sugar, Diet, and Exercise for Type I and Type II Diabetes. Tennessee, New Jersey: Fair Winds Press. DeCherney, A. H., & Nathan, L. (2002).
3. Current Obstetric and Gynecologic Diagnosis and Treatment. New York, U. S. A: McGraw-Hill Professional. Gill, G. (2004).
4. Unstable and Brittle Diabetes. Chicago, U. S. A: Informa Health Care. Marso, S. P. , & Stern, D. M. (2003).
5. Diabetes and Cardiovascular Disease: Integrating Science and Clinical Medicine. New York, U. S. A: Lippincott Williams & Wilkins. Montella, K. , Keely, E. , & Lee, R. V. (2008). Medical Care of the Pregnant Patient. London, New York: ACP Press.

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