Brittle diabetes is a term that some health experts use to describe diabetes that is especially hard to manage. While the American Diabetes Association does not recognize this term, other groups do. Could you have brittle diabetes? Read on to learn more.
Brittle diabetes, defined
Sometimes called “labile diabetes” or “unstable diabetes,” brittle diabetes pertains mainly to people who have type 1 diabetes who have frequent and severe swings in their blood sugars. These blood sugar swings can lead to frequent low blood sugars, or hypoglycemia, as well as frequent high blood sugars, or hyperglycemia that can cause diabetic ketoacidosis (DKA). These wide blood sugar fluctuations can lead to hospitalization, and can be very challenging for a person to manage.
The term “brittle diabetes” was described by Dr. R.T. Woodyatt, a physician from Chicago, in 1934 “to describe individuals with large, unexplained changes in blood glucose concentrations,” according to a January 2021 article in the Journal of Diabetes and its Complications. The authors of this article go on to write that the definition of brittle diabetes evolved to describe this condition in a person whose “life was constantly disrupted by episodes of hypoglycemia or hyperglycemia.”
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Brittle diabetes is considered to be rare, affecting three out of every 1000 people with type 1 diabetes, although it’s hard to know precisely what percent of the population has this condition.
Brittle diabetes is not without controversy. Some people dislike the term “brittle, noting that it can come across as being condescending and may convey that the person is to blame; as a result, the terms “unstable” or “dangerous” diabetes may be more appropriate. Another term that some people prefer is “high glucose variability.” Others believe that brittle diabetes doesn’t exist.
However, left untreated, brittle diabetes can lead to complications with the heart, kidneys, eyes, and nerves, problems with pregnancy, a lower quality of life, and a shortened life expectancy.
Causes of brittle diabetes
While people with type 1 diabetes are most at risk for brittle diabetes, it’s possible that people with type 2 diabetes for a long duration can get this condition, too. Also, while people of any age may experience this condition, research suggests that women may be affected more often than men. Adolescents and young adults with type 1 diabetes may be particularly affected; these groups may struggle with having diabetes, adhering to an insulin regimen, and being responsible for diabetes self-care. Older adults with type 1 diabetes may develop brittle diabetes as a result of cognitive impairment or difficulty affording food or insulin, for example.
Certain factors and conditions may predispose someone for having brittle diabetes. The website Beyondtype1.org shares some of the more common causes:
- Celiac disease
- Hypothyroidism
- Adrenal insufficiency
- Malabsorption
- Insulin resistance
- Impaired glucose counter-regulation (when the body doesn’t react as it should when blood sugars drop)
- Drug or alcohol use
- Emotional stress
- Depression
Other causes include:
- Gastroparesis
- Eating disorders
- Insulin or food insecurity
- Dementia and other types of cognitive impairment
- Other psychological conditions
Symptoms of brittle diabetes
Brittle diabetes can cause sudden and frequent changes in blood sugar levels, either hypoglycemia or hyperglycemia. These blood sugar swings can occur for no apparent reason.
Symptoms of hypoglycemia include:
- Shaking
- Sweating
- Dizziness
- Weakness
- Hunger
- Fatigue
- Rapid heart rate
- Confusion
Symptoms of hyperglycemia include:
- Headache
- Frequent urination
- Thirst
- Hunger
- Fatigue
- Weakness
- Irritability
Left untreated, hyperglycemia can quickly lead to diabetic ketoacidosis (DKA), a serious and potentially life-threatening condition.
Symptoms of DKA include:
- High blood sugars
- High levels of ketones in the urine
- Extreme thirst
- Frequent urination
- Nausea or vomiting
- Stomach pain
- Difficulty breathing
- Flushed skin
- Confusion
- Fruity-smelling breath
- Coma
Diagnosing brittle diabetes
There are no set criteria for diagnosing brittle diabetes, and it may take a long time for this condition to be diagnosed. Precipitating factors, such as depression or an eating disorder, may lead to changes in self-care and an inability to manage blood sugars. This can result in those wide swings in blood sugars, and may also lead to ER visits or hospitalizations, especially if they result in DKA.
A health care provider may diagnose this condition by reviewing blood sugars levels, medical or mental health conditions, and frequency of DKA, ER visits, and hospitalizations.
Treating brittle diabetes
A key approach to treating brittle diabetes is to target the underlying issue, whether it’s gastroparesis, hypothyroidism, an eating disorder, or stress. Behavioral therapy may be recommended (and can be very effective) to help manage this condition.
Some people can benefit from being hospitalized to help regulate insulin doses, food intake, physical activity, and stress responses.
Other tools for treating this condition may include:
- Use of CGM (continuous glucose monitoring)
- Use of an insulin pump
- Consistency with carbohydrate intake
- Establishing a regular physical activity routine
- Regular and adequate sleep
- Stress management practices
In some cases, a pancreas or islet cell (insulin-producing cells) transplant may be recommended.
A newer technology, called an artificial pancreas, may also be an option. This technology involves automation of insulin doses in response to blood sugar levels. An artificial pancreas consists of a CGM, insulin pump, and a program that calculates how much insulin is needed and signals the pump when insulin should be delivered. For more on the artificial pancreas, visit the website of the NIDDK.
Want to learn more diabetes basics? Read “Welcome to Diabetes” for type 2, “Type 1 Diabetes Questions and Answers” for type 1, and “Gestational Diabetes: Are You at Risk?” for gestational diabetes.
