Brittle diabetes is common in people with type 1 or type 2 diabetes. It not only affects older adults, but also teenagers. Know all about this severe form of diabetes.
If you have diabetes, you must be doing everything to manage it. You may be following a healthy diet with no sugar, taking insulin when needed, and staying active. But there are times when it gets really hard to manage diabetes and this can affect the quality of life. That’s called brittle diabetes or labile diabetes, which is a severe form of this health condition. It is not an official medical diagnosis but a way to describe diabetes that is hard to manage. Characterised by frequent and unpredictable fluctuations in blood glucose levels, it can occur in people with type 1 or type 2 diabetes.
What is brittle diabetes?
It is a common term used by doctors to describe hard to manage diabetes. “In case of brittle diabetes, blood glucose levels fluctuate unpredictably, causing extreme highs (hyperglycemia) and lows (hypoglycemia) despite the use of insulin and other diabetes management strategies,” shares endocrinologist and diabetologist Dr Piyush Lodha.
Back in 1934, American physician R.T. Woodyatt used the term for the first time to describe people with unexplained changes in blood glucose levels. Since then, the definition of brittle diabetes has evolved. Now, doctors use it to describe diabetes in a person whose life is constantly affected by hypoglycemia or hyperglycemia episodes, as per research published in the Journal Of Diabetes And Its Complications in 2020.
Prevalence of brittle diabetes
It is common in people with type 1 or type 2 diabetes complicated by severe insulin deficiency. About 12 out of every 10,000 adults with diabetes have it, according to research published in the Diabetes, Metabolic Syndrome and Obesity journal in 2023.
As for the age, it may affect elderly people but the peak age-group for brittle diabetes is 15 to 30, according to research published in the Journal Of the Royal Society of Medicine in 2001.
What are the symptoms of brittle diabetes?
The primary symptom of brittle diabetes is erratic blood glucose levels, which can cause both low blood sugar and high blood sugar.
Symptoms of hypoglycemia (low blood sugar):
- Shaking or trembling
- Sweating
- Confusion or difficulty concentrating
- Dizziness or lightheadedness
- Irritability or mood swings
- Rapid heartbeat
- Fatigue or weakness
- Fainting, seizures, or loss of consciousness (in severe cases)
Symptoms of hyperglycemia (high blood sugar):
- Increased thirst
- Frequent urination
- Blurry vision
- Nausea and vomiting (in extreme cases)
- Dry mouth and skin
- Fatigue or weakness
What are the causes of brittle diabetes?
The exact cause of brittle diabetes is not clear, but a few factors can contribute to it:
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1. Insulin sensitivity and resistance
In type 1 diabetes, the immune system destroys insulin-producing beta cells in the pancreas, making insulin administration essential. “In case of type 2 diabetes, the body becomes resistant to insulin. Both of these issues can cause fluctuations in blood glucose levels,” says Dr Lodha.
2. Hormonal imbalance
Stress-related hormones such as cortisol, adrenaline, and growth hormone can affect insulin sensitivity, leading to unpredictable blood sugar levels. For example, an illness can cause blood sugar levels to rise rapidly, even in well-controlled diabetics.
3. Stress and emotional factors
Anxiety, depression, and stress can exacerbate blood sugar instability in people with diabetes. “Mental stress can lead to hormonal changes that interfere with insulin function, causing wild fluctuations in blood glucose levels,” says the expert.
4. Autoimmune condition
An autoimmune condition like celiac disease, that occurs when you eat gluten, can contribute to blood sugar instability. During a 2021 study, published in the Journal Of The ASEAN Federation Of Endocrine Societies, researchers found that people experiencing brittle diabetes may be due to untreated celiac disease.
How is brittle diabetes diagnosed?
“Diagnosing brittle diabetes typically involves monitoring blood glucose patterns and assessing the frequency of extreme fluctuations,” says the expert.
- Blood sugar monitoring: The key to diagnosis is observing frequent, severe blood sugar fluctuations (both high and low) that are not easily explained by typical factors such as meals, exercise, or insulin use.
- Exclusion of other causes: Doctors will rule out other conditions that could explain the fluctuations, such as insulin resistance or hormonal imbalance.
- Evaluation of medical history: A thorough history of diabetes management, including insulin use, exercise routines, meal patterns, and any emotional or psychological stressors, is important.
How to treat brittle diabetes?
“Treatment for brittle diabetes focuses on stabilising blood glucose levels and reducing the severity of blood sugar fluctuations,” says Dr Lodha. The following are common treatment strategies:
1. Insulin therapy
Close monitoring and adjustments to insulin dosage are essential for managing brittle diabetes. “Some people may benefit from insulin pumps or continuous glucose monitoring systems to provide more precise control,” says the expert.
2. Frequent blood glucose monitoring
Regular blood sugar checks are important for people with diabetes. They are critical to identifying and addressing fluctuations before they become dangerous. Some people may need to check their blood sugar levels several times a day, including overnight.
3. Psychological support
Part of brittle diabetes treatment is managing mental stress. “Counseling, therapy or stress management techniques may help to cope with the psychological aspects of brittle diabetes, which can contribute to blood sugar instability,” says the expert.
4. Manage co-existing conditions
People with underlying conditions like celiac disease may be told to manage them. In case of celiac disease, going for a gluten-free diet is the best way to manage it. So, staying away from wheat, barley, semolina, and other foods with gluten will be beneficial.
5. Pancreas transplant
Pancreas, a gland in the abdomen, releases insulin as a response to glucose in the bloodstream. The insulin then notifies the cells in the body to take glucose from the blood. Then the body cells use it for energy production. The pancreas needs to function properly otherwise the body won’t be able to process glucose in the correct manner. A 2013 study, published in the Diabetes Care journal, showed that pancreas transplants have high success rates in the management of brittle diabetes.
6. Diet and lifestyle changes
A consistent, balanced diet and regular physical activity can help maintain stable blood sugar. “Choose foods like whole grains, vegetables, fruits, and legumes,” says the expert. Working with a registered dietitian and an exercise expert can turn out to be beneficial.
Brittle diabetes is characterised by extreme and unpredictable swings in blood glucose levels. It can be managed with careful attention to insulin therapy, diet, emotional well-being, and regular monitoring.
Related FAQs
Is brittle diabetes more common in elderly people?
Brittle diabetes is not more common in elderly people, but older adults with diabetes may face more challenges managing blood sugar. They may experience more difficulty managing brittle diabetes due to factors like reduced kidney function, slower metabolism, medication side effects, and the presence of multiple chronic health conditions.
Is brittle diabetes genetic?
Brittle diabetes itself is not inherited, but there is a genetic component to type 1 diabetes, which is the more common form associated with brittle diabetes. Individuals with a family history of type 1 diabetes may have a higher risk of developing it. Certain genetic conditions or predispositions may also make a person more prone to unstable blood sugar levels, but brittle diabetes itself is not directly passed down through generations.
Can brittle diabetes be reversed?
It is a chronic condition that requires lifelong management. While the extreme fluctuations in blood sugar cannot be entirely eliminated, they can be controlled through careful monitoring, insulin adjustments, a balanced diet, and emotional support. With proper treatment, many people with brittle diabetes can achieve more stable blood sugar levels and reduce the risk of complications.
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