Posters
Presenting Author Academic/Professional Position
Residency
Academic Level (Author 1)
Resident
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Internal Medicine
Academic Level (Author 2)
Faculty
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Internal Medicine
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Community/Public Health
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Research/Clinical
Abstract
“Brittle diabetes” describes a form of diabetes marked by severe, unpredictable fluctuations in blood glucose, often leading to frequent episodes of hypoglycemia and hyperglycemia. Though not formally recognized by major diabetes organizations, the term is clinically useful, especially for vulnerable populations such as older adults with Type 1 Diabetes Mellitus (T1DM). Age-related factors—cognitive impairment, mobility limitations, dexterity issues, sensory decline, inconsistent eating habits, and frailty—make glycemic control particularly challenging and require a personalized, multidisciplinary management approach.
We report the case of a 66-year-old Hispanic female with long-standing T1DM, seizure disorder, and osteoporosis. Despite adherence to a prescribed insulin regimen, her A1C remained elevated (9.5%–11.4%), with frequent early morning hypoglycemia and significant glucose variability. She often skipped insulin doses or consumed excess carbohydrates in response to hypoglycemia, further destabilizing her glucose control. Her diet was inconsistent, and physical activity minimal. CGM revealed an average glucose of 290 mg/dL with only 12% time in range. Lab work showed elevated cholesterol and LDL levels.
Although an insulin pump was recommended, the patient opted for an intensified basal-bolus regimen with increased Humalog and was prescribed Gvoke HypoPen. Management included education on insulin use, hypoglycemia prevention, and lifestyle changes.
Conclusion: This case highlights the complexity of managing diabetes in older adults, where comorbidities and cognitive decline compound the challenges. A patient-centered approach, guided by the “4Ms” (Mentation, Medications, Mobility, and What Matters Most), is essential to reduce risks, individualize targets, and improve outcomes in this high-risk population.
Presentation Type
Poster
Recommended Citation
Irfan, Saba and Cantu, Amanda, "Geriatric Brittle Type 1 Diabetes Mellitus: Case Study and Management Strategies" (2025). Research Colloquium. 88.
https://scholarworks.utrgv.edu/colloquium/2025/posters/88
Geriatric Brittle Type 1 Diabetes Mellitus: Case Study and Management Strategies
“Brittle diabetes” describes a form of diabetes marked by severe, unpredictable fluctuations in blood glucose, often leading to frequent episodes of hypoglycemia and hyperglycemia. Though not formally recognized by major diabetes organizations, the term is clinically useful, especially for vulnerable populations such as older adults with Type 1 Diabetes Mellitus (T1DM). Age-related factors—cognitive impairment, mobility limitations, dexterity issues, sensory decline, inconsistent eating habits, and frailty—make glycemic control particularly challenging and require a personalized, multidisciplinary management approach.
We report the case of a 66-year-old Hispanic female with long-standing T1DM, seizure disorder, and osteoporosis. Despite adherence to a prescribed insulin regimen, her A1C remained elevated (9.5%–11.4%), with frequent early morning hypoglycemia and significant glucose variability. She often skipped insulin doses or consumed excess carbohydrates in response to hypoglycemia, further destabilizing her glucose control. Her diet was inconsistent, and physical activity minimal. CGM revealed an average glucose of 290 mg/dL with only 12% time in range. Lab work showed elevated cholesterol and LDL levels.
Although an insulin pump was recommended, the patient opted for an intensified basal-bolus regimen with increased Humalog and was prescribed Gvoke HypoPen. Management included education on insulin use, hypoglycemia prevention, and lifestyle changes.
Conclusion: This case highlights the complexity of managing diabetes in older adults, where comorbidities and cognitive decline compound the challenges. A patient-centered approach, guided by the “4Ms” (Mentation, Medications, Mobility, and What Matters Most), is essential to reduce risks, individualize targets, and improve outcomes in this high-risk population.
