What is brittle diabetes?

Brittle diabetes is diabetes that’s especially difficult to manage and often disrupts everyday life. People with brittle diabetes have severe swings in blood glucose (blood sugar). The swings can cause frequent episodes of hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar).

Brittle diabetes is sometimes called labile diabetes or unstable diabetes.

What’s the difference between diabetes and unstable diabetes?

With treatment and lifestyle changes, most people with diabetes can live healthy lives. But people with brittle diabetes have frequent problems managing the disease that can:

• Affect their ability to live life normally.
• Cause anxiety and depression.
• Lead to hospitalization or even death.

How common is brittle diabetes?

Brittle diabetes is rare. It affects only about 3 of every 1,000 people with insulin-dependent diabetes.

Who might get brittle diabetes?

Brittle diabetes occurs most often in people with Type 1 diabetes (in Type 1, the body does not produce insulin). For reasons not fully understood, it’s most common in women in their 20s and 30s.

What causes brittle diabetes?

Brittle diabetes occurs when diabetes is especially difficult to manage-. Diabetes can be hard to manage for many reasons:

• Celiac disease, an autoimmune disorder that affects the intestine.
• Drug or alcohol use.
• Eating disorders.
• Gastroparesis, a condition in which nerve damage prevents the stomach from emptying food properly.
• Hormonal imbalances, such as adrenal insufficiency and hypothyroidism.
• Problems in the way the body absorbs insulin or nutrients from food.
• Stress, anxiety, depression and other psychological issues that can make the body resist insulin.

What are the symptoms of brittle diabetes?

People with brittle diabetes experience sudden and frequent changes in blood glucose levels for no obvious reason. The swings lead to hypoglycemia or hyperglycemia.

Symptoms of hypoglycemia include:

• Dizziness, weakness or shaking.
• Fast heart rate.
• Irritability or confusion.
• Pale skin.
• Restless sleep.
• Sweating.
• Sudden hunger.

Symptoms of hyperglycemia include:

• Blurry vision.
• Fatigue (feeling weak, tired).
• Frequent urination (peeing).
• Headache.
• Skin infections and slow-healing cuts.
• Thirst or hunger.

Untreated hyperglycemia can lead to diabetes-related ketoacidosis (DKA), a complication of diabetes, which can cause:

• Confusion.
• Dehydration.
• Fast heart rate.
• Fruity-smelling breath.
• Trouble breathing.
• Vomiting.
• Coma.

How is labile diabetes diagnosed?

Brittle diabetes is diagnosed after severe, frequent episodes of hypoglycemia or hyperglycemia that disrupt life or lead to hospitalizations. A healthcare provider specializing in diabetes (endocrinologist) can diagnose brittle diabetes by reviewing your blood glucose levels over time.

How is brittle diabetes treated?

Several treatments and technologies can help people with brittle diabetes managethe condition. They include:

• Continuous glucose monitor.
• Insulin pump.
• Islet cell transplantation: A healthcare provider takes healthy insulin-producing cells from a deceased person’s pancreas and infuses them into the liver.
• Pancreas transplant: A surgeon implants a donated pancreas.

Your healthcare provider will try to address any underlying causes of brittle diabetes. For example, therapy to lessen psychological issues and stress can help manage diabetes.

How can I prevent brittle diabetes?

It’s not always possible to prevent brittle diabetes, depending on the underlying cause. Monitoring your blood glucose regularly and closely following your healthcare provider’s instructions can help.

What is the outlook and life expectancy with brittle diabetes?

If blood sugar is not managed well, the outlook for people with brittle diabetes is poor, involving:

• Complications, such as problems with the eyes, kidneys, heart and nerves.
• Frequent hospitalizations.
• Low quality of life.
• Problems with pregnancy.
• Shorter life expectancy.

How can people with brittle diabetes care for themselves?

If you have diabetes, it’s essential to manage your blood glucose levels:

• Eat a healthy diet low in sugar and carbohydrates to lessen swings in blood glucose.
• Exercise regularly.
• Follow your healthcare provider’s instructions carefully.
• Maintain a healthy weight.
• Take diabetes medications exactly as prescribed.
• Test blood glucose frequently.
• Track problems with blood glucose and what may have caused them (for example, in a journal).

When should I seek medical attention for brittle diabetes?

If you have frequent hypoglycemia or hyperglycemia symptoms, talk to your healthcare provider. Seek immediate medical attention if you experience diabetes-related ketoacidosis (DKA) symptoms, especially:

• Confusion or dizziness.
• Fast heart rate.
• Trouble breathing.
• Vomiting.

A note from Cleveland Clinic

Brittle diabetes is diabetes that is especially difficult to manage. Severe, unpredictable swings in blood glucose cause frequent episodes of hypoglycemia or hyperglycemia. Talk to your healthcare provider if you’re having trouble managing blood sugar. Special equipment or treatment of another underlying condition may be able to help.