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What Is ‘Brittle’ Diabetes?


Updated May 20, 2014

Brittle diabetes, also called labile diabetes, is a term used to describe uncontrolled type 1 diabetes. People with brittle diabetes frequently experience large swings in blood sugar (glucose) levels. These cause either hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar), which is more common and sometimes extreme.

Other Conditions Related to Brittle Diabetes

Brittle diabetes can be caused by gastrointestinal absorption problems, including delayed stomach emptying (gastroperesis), drug interactions, problems with insulin absorption, or hormonal malfunction.

People who have severely low blood sugar levels may also have problems with their thyroid (hypothyroidism) and adrenal glands (adrenal insufficiency). Treatment of these conditions often leads to the resolution of brittle diabetes.

Gastroperesis can affect relative absorption rates of food, glucose and insulin into the bloodstream. The problem can be a side effect of damage to the nerves that control internal organs. This is a condition that sometimes occurs in people with diabetes. Medications such as Reglan (metoclopramide) do help to encourage more normal stomach emptying. Studies have found, though, that treating gastroperesis does not lead to improvements in overall control of the diabetes or its related complications.

Psychological problems, including depression and stress, are also often associated with brittle diabetes.

Difference between Brittle and Stable Diabetes

The blood sugar levels of people with stable diabetes may fluctuate occasionally. However, these fluctuations are not frequent and -- unlike brittle diabetes -- do not impact the ability to carry out regular activities of daily living.

Brittle Diabetes and the Family

The person with brittle diabetes is frequently hospitalized, misses work and often has to contend with psychological problems. All of these factors place additional emotional and financial stress on family members.

How Often Does Brittle Diabetes Occur?

Brittle diabetes is relatively rare. Less than 1 of people who have insulin-dependent diabetes patients experience brittle diabetes. However, those who do are often troubled by frequent medical problems and hospital admissions. Overall, three in 1,000 (0.3 of) people with type 1 diabetes will develop brittle diabetes.

Who Gets Brittle Diabetes and Why

People with psychological problems, such as stress and depression, are at highest risk of experiencing brittle diabetes. In some cases, these psychological problems lead them to neglect self-care for their diabetes. For example, they may stop maintaining a healthy diet or may not manage their blood sugar). As blood sugar control wanes, metabolic imbalances further complicate and often worsen the underlying psychological problems, causing a repetitive cycle of brittle diabetes.

One small study documented that people with brittle diabetes have a greater hormonal response to stress than those whose diabetes is not brittle. This psychological-hormonal connection may influence the development of brittle diabetes.

Brittle diabetes is more common in young women, with overweight women more likely to be affected. Most people with brittle diabetes tend to be between the ages of 15 and 30.

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