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Brittle diabetes is a severe form of type 1 diabetes. This article outlines the risk factors, symptoms and treatment of brittle diabetes.

Diabetes is a disease in which patients have high levels of glucose (a type of sugar) in their blood, leading to several complications if the disease left untreated. There are two major types of diabetes:

  • Type 1 diabetes. Patients with type 1 diabetes have a deficiency of insulin, a hormone that metabolizes glucose. Type 1 diabetes develops because the immune system mistakenly attacks cells of the pancreas that produce insulin. Patients with type 1 diabetes often fluctuate in their levels of blood glucose, going from high to low.
  • Type 2 diabetes. Patients with type 2 diabetes have sufficient levels of insulin. However, the cells of the body are no longer sensitive to insulin. Thus, insulin does not have its intended effect, leading to high levels of glucose in the blood.

Brittle diabetes, sometimes called labile diabetes, is a rare, more severe subtype of diabetes. Patients with brittle diabetes experience unexpected highs and lows in their blood glucose levels, which can lead to severe complications and even cause you to be hospitalized.

As brittle diabetes can be kept at bay with treatment, it is uncommon. However, it is still known to develop in some patients with diabetes. Often, if it develops, it is a sign that your blood glucose levels are not managed properly. The optimal way to prevent brittle diabetes is to follow the advice of your doctors when it comes to managing your condition.

Brittle diabetes: Risk factors

People with type 1 diabetes are more likely to develop brittle diabetes, though it can (rarely) occur in patients with type 2 diabetes as well. Therefore, while some doctors consider brittle diabetes a complication of diabetes, many see it as a severe form of type 1 diabetes. For patients with type 1 diabetes, these are the risk factors for developing brittle diabetes:

  • Gender. Females are more likely to develop brittle diabetes than males.
  • Hormone levels. Studies have shown that patients who have hormone imbalances are more likely to develop brittle diabetes.
  • Weight. Overweight or obese patients are more likely to develop brittle diabetes.
  • Hypothyroidism. Patients who have low levels of thyroid hormones are more likely to develop brittle diabetes compared to patients with normal thyroid hormone levels.
  • Age. Patients in their twenties or thirties are more likely to develop brittle diabetes.
  • Stress. Patients who experience stress regularly are more likely to develop brittle diabetes.
  • Depression. Depressed patients are more prone to developing brittle diabetes.
  • Celiac disease

Symptoms of brittle diabetes

Symptoms in patients with brittle diabetes are related to constant blood glucose fluctuations. These are symptoms type 1 or type 2 diabetics also experience when they have uncontrolled glucose levels. Patients with brittle diabetes, however, will experience these symptoms quite frequently:

  • Feeling dizzy
  • Feeling weak
  • Feeling irritable
  • Excessive hunger
  • Trembling hands
  • Impaired or double vision
  • Headaches, often very severe
  • Issues with sleeping
  • Excessive thirst
  • Frequent urination
  • Dry skin

Treatment: How can brittle diabetes be managed?

The primary way to treat brittle diabetes is managing your blood sugar levels. These are the different ways that you can use to balance your blood glucose levels:

  • Continuous glucose monitoring. First things first, you need to be able to continuously monitor your blood glucose levels to make sure they are not fluctuating. In the case of brittle diabetes, you should do this multiple times a day. You can do this by using a sensor that is placed under your skin that continuously detects the level of glucose in your blood throughout the day. It will also alert you when your blood glucose levels get too high or too low so you know to adjust your insulin dose accordingly. This is a very handy tool for patients with brittle diabetes.
  • Insulin pump. Essentially, the goal of treating brittle diabetes is to be able match the amount of insulin you need to the amount that you are taking. This can be effectively done using a subcutaneous insulin pump, a small pump that goes right into your belt or pocket. The pump is attached to a needle that goes into your skin and continuously pumps insulin into your body to keep your insulin levels balanced.

Generally, continuous glucose monitoring and an insulin pump are sufficient to treat brittle diabetes. In severe cases, your blood glucose levels might still not be well-controlled, and many need other treatment options. These can include:

  • Pancreas transplant. Since your pancreas makes the insulin that is needed by your body, a pancreas that doesn't work properly means your body won’t be able to make insulin properly. In this case, you may be a candidate for a pancreas transplant, which studies have shown can work well in the treatment of brittle diabetes.
  • Artificial pancreas. While currently in development, clinical studies are underway to evaluate the use of an artificial pancreas for the treatment of brittle diabetes.

Conclusion

Brittle diabetes is a condition that, while severe, can be managed with appropriate treatment. Make sure you stay in constant contact with your doctor and monitor your blood glucose levels.

  • Pickup, John, and Harry Keen. "Continuous subcutaneous insulin infusion at 25 years: evidence base for the expanding use of insulin pump therapy in type 1 diabetes." Diabetes care 25.3 (2002): 593-598.
  • Bertuzzi, Federico, et al. "Brittle type 1 diabetes mellitus." Current medicinal chemistry 14.16 (2007): 1739-1744.
  • Gill, G. V., S. Lucas, and L. A. Kent. "Prevalence and characteristics of brittle diabetes in Britain." QJM: An International Journal of Medicine 89.11 (1996): 839-844.
  • Photo courtesy of SteadyHealth

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