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Brittle diabetes is a term that is sometimes used to describe hard-to-control diabetes (also called labile diabetes). It is characterized by wide variations or “swings” in blood glucose (sugar) in which blood glucose levels can quickly move from too high (hyperglycemia) to too low (hypoglycemia). These episodes are hard to predict and can disrupt quality of life. They can require frequent or lengthy hospitalizations and can be fatal.
People with type 1 diabetes are at greatest risk. While many people with type 1 diabetes experience hypoglycemia, only a small proportion of people with type 1 diabetes experience the frequent blood glucose swings described as “brittle.” People with long-standing type 2 diabetes may also have difficulty controlling blood glucose, but few have these frequent swings. People of any age with diabetes can be affected with these frequent ups and downs in blood glucose levels. Some research suggests that women may be affected more often than men.
Frequent episodes of hypoglycemia can lead to hypoglycemic unawareness and make the condition worse. Keeping diabetes under good control for at least several weeks can restore hypoglycemic awareness. New technologies such as continuous glucose monitors and insulin pumps may help improve control.
In diabetes, many factors can trigger frequent changes in blood glucose levels. For example, people who don’t test blood glucose or take diabetes medications as prescribed often experience significant fluctuations in blood glucose levels. Other causes of unstable blood glucose levels include emotional stress, eating disorders, drug or alcohol use, malabsorption, gastroparesis, and celiac disease.
The development of new treatments for diabetes has made it easier for most people to control their blood glucose levels. Artificial pancreas technology is currently being tested in clinical trials and aims to help people with type 1 diabetes more easily manage blood glucose levels. In 2016, the U.S. Food and Drug Administration approved a hybrid model of an artificial pancreas, an automated system that requires users to adjust insulin intake at mealtimes. NIH-funded research on islet cell transplantation has also shown promising results in restoring blood glucose control. This research specifically includes people who have experienced episodes of severe hypoglycemia.
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