Brittle diabetes is also known as labile diabetes and is a term used to describe hard to control type 1 diabetes where the blood glucose levels reach both extremes of high and low levels (hyperglycaemia and hypoglycaemia) at any one time.
Brittle diabetes can be caused by insulin absorption problems, drug interaction, gastrointestinal problems and malfunctioning hormones. It can also be associated with psychological issues such as depression and stress.
Stable diabetes have fluctuating blood glucose levels although not frequent, that is why we have to test them regularly with our BG meter but in brittle diabetes these levels fluctuate very frequently to the stage where a person cannot perform their daily duties are often very ill due to these frequent fluctuations and they often miss work that is if they are even well enough to work! This then places even more stress due to financial difficulties.
A hospital stay for some weeks is required to stabilise BG levels to an acceptable level. They may also benefit for an insulin pump to regulate their BG levels in a precise fashion. People with very severe brittle diabetes may be considered for isolated islet transplant or pancreas transplant, although it is relatively new and there are significant risks involved.
Sometimes a fresh start in diabetes education is the best option, making sure that patients are fully aware of a good regime in taking insulin and eating at proper times and learning how to estimate food portion sizes. I can fully recommend DAFNE, which is a diabetes education program in some European countries. Although not available in the U.S and Canada, many diabetes educators are putting patients on ‘insulin ration / sliding scale’ programs