What to know about brittle diabetes

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Also known as labile diabetes, brittle diabetes is a term that describes a rare form of diabetes that is difficult to control. While the American Diabetes Association (ADA) does not recognize the term, it notes that people may use the term to refer to extreme fluctuations in their blood sugar levels.

Brittle diabetes involves characteristic variations, or swings, in blood sugar levels that can quickly move from being too high to too low and vice versa. Episodes of erratic glycemic control are difficult to predict, can disrupt a person’s quality of life, and may result in hospitalization and complications.

Brittle diabetes is a descriptive term that may feel condescending to some people and may also convey a sense of blame, which is inaccurate. Researchers suggest that “unstable diabetes” or “dangerous diabetes” would be a more accurate term. In many cases, the condition may have an underlying cause, such as a medical condition, aging, or healthcare inequity.

Evidence suggests that people living with type 1 diabetes have the highest risk of experiencing brittle diabetes. The condition may also occur in individuals with long-standing type 2 diabetes, but this is more rare. Although research suggests that brittle diabetes can affect people of any age, it may affect females more often than males.

The exact cause is unknown, but a 2021 article highlights that many possible factors may contribute toward the characteristic glycemic instability of brittle diabetes. It also suggests four groups of people who may be more likely to experience brittle diabetes:

• younger individuals with mental health complications
• people with an underlying medical condition affecting their insulin sensitivity or glucose utilization
• older adults who have difficulty managing their diabetes
• individuals without access to sufficient insulin who may also experience food insecurity

Research also notes potential factors that may affect diabetes and make it difficult to control, including:

• hormonal imbalances
• malabsorption of insulin or nutrients, or health conditions affecting digestion
• difficulty adhering to the treatment plan, such as not checking blood sugar regularly or not taking medications as prescribed
• hypoglycemic unawareness
• emotional stress
• substance misuse
• eating disorders

For example, a 2021 case study highlights an individual experiencing brittle diabetes due to an underlying and untreated autoimmune condition called celiac disease.

Brittle diabetes will likely cause a person to experience sharp and frequent changes in their blood glucose levels. As a result, they may have periods of severe hyperglycemia, which can contribute to diabetic ketoacidosis, and periods of severe hypoglycemia.

The symptoms of hypoglycemia can include:

• hunger
• tiredness
• sweating
• shaking
• rapid or irregular heart rate
• dizziness and weakness
• confusion
• seizures
• fainting
• coma

The symptoms of hyperglycemia may include:

• frequent urge to urinate
• excessive thirst
• intense, unusual hunger
• headaches
• blurred vision
• unexplained weight loss
• fatigue
• irritability

Brittle diabetes involves frequent and severe fluctuations of blood glucose and episodes of hyper- and hypoglycemia that may require hospitalization. As such, a healthcare professional specializing in diabetes can review a person’s blood glucose over time and diagnose brittle diabetes.

Ongoing research is attempting to define diagnostic criteria. A current clinical trial suggests that a person may have brittle diabetes if they possess at least two of the following criteria:

• persistent, severe hypoglycemia
• ketoacidosis without an obvious cause
• diagnosis of unaware hypoglycemic episodes
• a score suggesting high glycemic variability according to different tests, such as low and high blood glucose indices and a mean blood glucose standard deviation

Treating and managing the condition will be largely similar to controlling type 1 diabetes, with people monitoring their blood glucose levels and maintaining them within healthy ranges. Typically, this may involve administering insulin and making adjustments to diet and exercise.

Some people may use devices and technology, such as a continuous glucose monitor or artificial pancreas, which can help track and manage their blood sugar levels. In other cases, if people are eligible, they may receive a pancreas or islet cell transplant.

A doctor will advise on the best treatment option for each person. Additionally, they will address any underlying conditions that may be causing brittle diabetes. For example, they may suggest therapy if stress or a mental health condition is the cause.

As brittle diabetes is associated with type 1 diabetes, the management of the conditions is similar. To help control their blood sugar, people should regularly check their glucose levels and follow their doctor’s advice. This may include eating a well-balanced diet, exercising regularly, and correctly administering insulin.

Currently, there is a lack of research regarding the life expectancy for those who experience brittle diabetes. However, people who are unable to control their blood glucose effectively are likely to experience health complications that can reduce their life expectancy.

Evidence suggests that males living with type 1 diabetes have a life expectancy of roughly 66 years, compared with 77 years among those without the condition. Females with type 1 diabetes have a life expectancy of about 68 years, while those without have a life expectancy of 81 years.

As brittle diabetes typically involves severe fluctuations that are hard to control, life expectancy will likely be affected. However, advances in technology and management are helping significantly improve life expectancy.

Depending on the underlying cause, people may not be able to prevent brittle diabetes. The best strategies people can implement are maintaining healthy blood glucose levels and using insulin and diabetes technology. It is also advisable to attend regular doctor appointments and to try to manage other underlying health conditions.

If a person begins to experience symptoms of hypo- or hyperglycemia frequently, consulting a doctor is advisable. Knowing the signs of diabetic emergencies and being able to respond to them promptly may save lives.

People require immediate medical care if they experience seizures or coma. It is also important to contact a doctor if a person frequently experiences the following symptoms:

• confusion
• nausea
• difficulty breathing
• vomiting
• rapid heart rate

Brittle diabetes is a term that describes a rare and difficult-to-manage form of diabetes. It involves frequent and severe swings in a person’s blood glucose levels, which often disrupt everyday life. It typically occurs due to factors negatively affecting the body’s use of nutrients and insulin.

The treatment is similar to that for type 1 diabetes and involves monitoring blood glucose and administering insulin. However, a person may require additional treatment to address any underlying causes of brittle diabetes.