“Brittle” has been loosely used to describe erratic blood glucose levels that are
difficult to control. The term “brittle patient” (or the double whammy, “brittle
diabetic”) implies that attempts to manage diabetes are futile. Those labeled “truly
brittle,” a term without any definition, may feel that health care providers have
given up on them. Fortunately, if people with erratic blood glucose levels work
with their providers, their diabetes can usually be managed with enhanced
treatment, technology, support, and education.
Because “brittle” carries so much baggage and doesn’t help improve health, the
overused label should be put to rest. The next step: encouraging scientists to define
solutions for people whose conditions defy the best that medicine has to offer.
We all cheat. And often. It’s human
nature. But ruminating on cheating
doesn’t help people with diabetes
move toward better outcomes. This
pejorative term is only good for one
thing: promoting self-punishment and
feelings of shame. It’s much more
effective to focus on all the healthy
choices you make each day. Praise is a
much better motivator than criticism.
complications of diabetes, n. pl.
The phrase “complications of diabetes”
assumes that complications are
inevitable. Although uncontrolled blood
glucose levels do correlate with some
complications, there are genetic and
unknown factors that play a role, too.
Repeatedly being hammered with
the possibility that you’ll develop
life-altering complications as a
means to motivate health behavior
(“Take better care of yourself or you’ll
lose a leg”) is harmful. Terror can
be paralyzing, making diabetes
management difficult. Let’s blame the
insidious nature of diabetes for the
damage, not the people living with it
and caring for it as best they can.
Denial is a normal reaction to
many things in life, including a
diabetes diagnosis, but it can be a
barrier to self-care. Some people
are mistakenly labeled as “in
denial,” and their state of mind is
blamed for their poor control. The
true barrier may actually be a lack
of understanding about diabetes
management or other factors, such
as lack of enough family support
or money, or depression (treating
it can help).
The closer you can get to
describing the issues that are
bothering you, the better you and
your support teams can work
together. Remind yourself that
you are the expert on your life and
that providers advise you based in
part on what you share. When you
shrug off good advice by saying,
“I’m in denial and can’t make any
changes,” you sell yourself short.
An attitude of denial can prevent
you from moving forward and
managing your condition. When
this is the case, mental health
providers are great assets.
Given that there
are so many things
that people have to
do to manage diabetes,
it is not surprising
most report feeling
like a failure at times.
people’s feedback only
reinforces this idea.
It’s hardly empowering
to hear that you’re a
“diet failure” or an
“oral agent failure.”
The same goes for
telling yourself you
failed to meet A1C
goals. Negative talk
like that does more
harm than good.
is a dynamic process,
not achieving a goal
can be redefined
as a moment of
providers and people
with diabetes can use
to assess the elements
of treatment that
aren’t working and
look at other options.
So, if oral medications
are no longer effective,
it may be time to
insulin. People with
better health and
quality of life when
treatment plans are
based on needs and
forecast.diabetes.org AUGUST 2012 35