Table of ContentsView AllTable of ContentsSymptomsCausesRisk FactorsDiagnosisTreatmentCoping
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Risk Factors
Diagnosis
Treatment
Coping
Some experts regard brittle diabetes as a subtype of type 1 diabetes, while others believe it’s a complication of the disease. Sometimes, brittle diabetes is associated with stress and other psychological issues. It may require hospitalization.
This article takes a closer look at the causes and symptoms of brittle diabetes, along with how it is treated, how it is diagnosed, and ways to cope with the disease.
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Brittle Diabetes Symptoms
The hallmark of brittle diabetes is frequent, unpredictable shifts in blood sugar levels, causing fluctuating symptoms of hyperglycemia and hypoglycemia.
Extreme swings in blood sugar due to brittle diabetes can negatively affect quality of life and require frequent hospitalization.
Symptoms of high blood sugarinclude:
Symptoms of low blood sugarinclude:
Hypoglycemia vs. Hyperglycemia
Ketoacidosis can rapidly lead todiabetic comaand even death.Symptoms of DKA include:
Vomiting is a sign that DKA may develop into a life-threatening condition in just a few hours.If you or a loved one are showing signs of DKA, seek immediate medical help.
Causes of Brittle Diabetes
Autonomic neuropathyis a complication of diabetes that can lead to brittle diabetes. Autonomic neuropathy can compromise the digestive processes that metabolize glucose and affect stomach and intestine function. This makes it difficult to judge how much insulin to take.
Brittle Diabetes Risk Factors
The primary risk factor for brittle diabetes is type 1 diabetes. Some studies suggest females are more likely to be affected than males.
Other risk factors for brittle diabetes include:
How Is Brittle Diabetes Diagnosed?
Identifying brittle diabetes can be tricky, as there are no specific metrics for diagnosis. Technically, the term “brittle diabetes” is a descriptive term—not an officially recognized form of diabetes.
Because of the lack of precision in the term, some healthcare providers diagnose the phenomenon as high glucose variability, simply meaning that the person experiences large swings in glucose levels.
Factors your healthcare provider will look for when checking your glucose variability include:
Brittle Diabetes Treatment
People with brittle diabetes may stop following a healthy diet or adequately managing their blood sugar. As blood sugar control wanes, metabolic imbalances further complicate and often worsen the underlying physical and psychological problems. This can lead to a repetitive cycle of glucose instability.
Balancing blood glucose levels to avoid erratic swings is the most effective way to treat brittle diabetes. Treatment may require a hospital stay of a few weeks with intensive monitoring of food, glucose, and insulin to restore glucose control.
In some cases, transferring to a different diabetes care team can serve as a helpful fresh start. Switching to a specialty diabetes center may help break the cycle of brittle diabetes.
Continuous glucose monitors and insulin pumps can be useful in the ongoing management of hypoglycemia and hyperglycemia. Technologies such as an artificial pancreas may also be helpful.
Continuous Glucose Monitors and Insulin Pumps
The more information you have regarding your blood sugar levels, the better you can manage your medications and reduce the frequency of blood glucose variability. For many people with type 1 diabetes, this may mean wearing a continuous glucose monitor and using an insulin pump.
Continuous glucose monitorscan alert you to dips or spikes in your blood sugar so you can take the necessary steps to get it under control. Some come equipped with safety alerts and alarms to notify you of rising or dropping levels before they get too serious.
Wearable Tech to Manage Your Diabetes
Psychological Treatment
Sometimes, an underlying psychological condition may be at play if your glucose levels respond normally to diabetes drugs and there are no other uncontrolled health conditions.If that’s the case, psychological treatment may help.
It’s helpful to consult a psychology professional for evaluation. Treatment may involve exploring the cause of your stress and trying a variety of methods to lessen it. Psychotherapy has proven to be particularly effective in the long-term treatment of diabetes.
Medication for the treatment of anxiety or depression may help, although some drugs may interact with diabetes medications. Beta-blockers and some mood stabilizers, for example, may worsen diabetes symptoms, and others may affect how diabetes medications act in your body.
Transplantation
Apancreas transplantor an islet cell transplantation can be an option for some people who have type 1 diabetes.
Allotransplantation, a type of islet cell transplantation, is used for a select population of people with type 1 diabetes who have a difficult time managing their blood sugar or have hypoglycemia unawareness.
Transplants are only performed in clinical research hospitals that have received approval from the Food and Drug Administration (FDA).
‘This Is Real Freedom’: Islet Cell Transplant Helps One Woman Become Insulin Independent
New Technologies
Most available models require the user to make some manual adjustments at mealtimes, though the latest model, approved in 2023, minimizes the work users need to do.
These systems can help take some of the guesswork out of insulin adjustments because they happen automatically.
Coping With Brittle Diabetes
People with brittle diabetes are frequently hospitalized, regularly miss work, and often have to contend with psychological problems. All these factors place additional emotional and financial stress on family members.
Many people find that working with a holistically-minded care team to employ stress reduction practices is helpful, both as a treatment for brittle diabetes and as a means to cope with it.
Daily practices to consider include meditation, deep breathing, gentle yoga, andacupuncture. These practices may be used alongside psychotherapy and medication as needed.
It’s important to reach out to your medical team for support for yourself and your family members.
Summary
Brittle diabetes is closely linked to mental health. When a psychological condition underlines brittle diabetes, your provider may recommend a combination of psychotherapy and medical treatment, such as a continuous glucose monitor, to get your blood sugar under control.
16 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Merck Manual.Diabetes mellitus (DM).American Diabetes Association.Understanding and managing low blood glucose (hypoglycemia).American Diabetes Association.Diabetes & DKA (ketoacidosis).Newman C, Dinneen SF.Brittle diabetes revisited: a description of erratic and difficult-to-control diabetes in an elderly woman with Type 1 diabetes.Diabet Med. 2020;37(10):1777-1780. doi:10.1111/dme.13972Centers for Disease Control and Prevention.Diabetic ketoacidosis.Cleveland Clinic.Brittle diabetes.Thewjitcharoen Y, Viriyautsahakul V, Sasijaroenrat N, et al.Celiac disease as a cause of anemia and brittle diabetes in type 1 diabetes mellitus.J ASEAN Fed Endocr Soc. 2021;36(2):227-230. doi:10.15605/jafes.036.02.19Feldman EL, Callaghan BC, Pop-Busui R, et al.Diabetic neuropathy.Nat Rev Dis Primers. 2019;5(1):42. doi:10.1038/s41572-019-0097-9UpToDate.Approach to the adult with brittle diabetes or high glucose variability.Hirsch I, Gaudini L.A new look at brittle diabetes.J Diabetes Complications. 2021;35(1):1-8. doi:10.1016/j.jdiacomp.2020.107646Liu J, Zhou L, Sun L, et al.Association between intestinalPrevotella copriabundance and glycemic fluctuation in patients with brittle diabetes.Diabetes Metabol Syndr Obes. 2023;2023(16):1613-1621. doi:10.2147/DMSO.S412872Harvey JN.Psychosocial interventions for the diabetic patient.Diabetes Metab Syndr Obes. 2015;8:29-43. doi:10.2147/DMSO.S44352National Institute of Mental Health.Mental health medications.Singh Kochar I, Jain R.Pancreas transplant in type 1 diabetes mellitus: the emerging role of islet cell transplant.Ann Pediatr Endocrinol Metab. 2021;26(2):86-91. doi:10.6065/apem.2142012.006National Institute of Diabetes and Digestive and Kidney Diseases.Pancreatic islet transplantation.Food and Drug Administration.FDA clears new insulin pump and algorithm-based software to support enhanced automatic insulin delivery.
16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Merck Manual.Diabetes mellitus (DM).American Diabetes Association.Understanding and managing low blood glucose (hypoglycemia).American Diabetes Association.Diabetes & DKA (ketoacidosis).Newman C, Dinneen SF.Brittle diabetes revisited: a description of erratic and difficult-to-control diabetes in an elderly woman with Type 1 diabetes.Diabet Med. 2020;37(10):1777-1780. doi:10.1111/dme.13972Centers for Disease Control and Prevention.Diabetic ketoacidosis.Cleveland Clinic.Brittle diabetes.Thewjitcharoen Y, Viriyautsahakul V, Sasijaroenrat N, et al.Celiac disease as a cause of anemia and brittle diabetes in type 1 diabetes mellitus.J ASEAN Fed Endocr Soc. 2021;36(2):227-230. doi:10.15605/jafes.036.02.19Feldman EL, Callaghan BC, Pop-Busui R, et al.Diabetic neuropathy.Nat Rev Dis Primers. 2019;5(1):42. doi:10.1038/s41572-019-0097-9UpToDate.Approach to the adult with brittle diabetes or high glucose variability.Hirsch I, Gaudini L.A new look at brittle diabetes.J Diabetes Complications. 2021;35(1):1-8. doi:10.1016/j.jdiacomp.2020.107646Liu J, Zhou L, Sun L, et al.Association between intestinalPrevotella copriabundance and glycemic fluctuation in patients with brittle diabetes.Diabetes Metabol Syndr Obes. 2023;2023(16):1613-1621. doi:10.2147/DMSO.S412872Harvey JN.Psychosocial interventions for the diabetic patient.Diabetes Metab Syndr Obes. 2015;8:29-43. doi:10.2147/DMSO.S44352National Institute of Mental Health.Mental health medications.Singh Kochar I, Jain R.Pancreas transplant in type 1 diabetes mellitus: the emerging role of islet cell transplant.Ann Pediatr Endocrinol Metab. 2021;26(2):86-91. doi:10.6065/apem.2142012.006National Institute of Diabetes and Digestive and Kidney Diseases.Pancreatic islet transplantation.Food and Drug Administration.FDA clears new insulin pump and algorithm-based software to support enhanced automatic insulin delivery.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Merck Manual.Diabetes mellitus (DM).American Diabetes Association.Understanding and managing low blood glucose (hypoglycemia).American Diabetes Association.Diabetes & DKA (ketoacidosis).Newman C, Dinneen SF.Brittle diabetes revisited: a description of erratic and difficult-to-control diabetes in an elderly woman with Type 1 diabetes.Diabet Med. 2020;37(10):1777-1780. doi:10.1111/dme.13972Centers for Disease Control and Prevention.Diabetic ketoacidosis.Cleveland Clinic.Brittle diabetes.Thewjitcharoen Y, Viriyautsahakul V, Sasijaroenrat N, et al.Celiac disease as a cause of anemia and brittle diabetes in type 1 diabetes mellitus.J ASEAN Fed Endocr Soc. 2021;36(2):227-230. doi:10.15605/jafes.036.02.19Feldman EL, Callaghan BC, Pop-Busui R, et al.Diabetic neuropathy.Nat Rev Dis Primers. 2019;5(1):42. doi:10.1038/s41572-019-0097-9UpToDate.Approach to the adult with brittle diabetes or high glucose variability.Hirsch I, Gaudini L.A new look at brittle diabetes.J Diabetes Complications. 2021;35(1):1-8. doi:10.1016/j.jdiacomp.2020.107646Liu J, Zhou L, Sun L, et al.Association between intestinalPrevotella copriabundance and glycemic fluctuation in patients with brittle diabetes.Diabetes Metabol Syndr Obes. 2023;2023(16):1613-1621. doi:10.2147/DMSO.S412872Harvey JN.Psychosocial interventions for the diabetic patient.Diabetes Metab Syndr Obes. 2015;8:29-43. doi:10.2147/DMSO.S44352National Institute of Mental Health.Mental health medications.Singh Kochar I, Jain R.Pancreas transplant in type 1 diabetes mellitus: the emerging role of islet cell transplant.Ann Pediatr Endocrinol Metab. 2021;26(2):86-91. doi:10.6065/apem.2142012.006National Institute of Diabetes and Digestive and Kidney Diseases.Pancreatic islet transplantation.Food and Drug Administration.FDA clears new insulin pump and algorithm-based software to support enhanced automatic insulin delivery.
Merck Manual.Diabetes mellitus (DM).
American Diabetes Association.Understanding and managing low blood glucose (hypoglycemia).
American Diabetes Association.Diabetes & DKA (ketoacidosis).
Newman C, Dinneen SF.Brittle diabetes revisited: a description of erratic and difficult-to-control diabetes in an elderly woman with Type 1 diabetes.Diabet Med. 2020;37(10):1777-1780. doi:10.1111/dme.13972
Centers for Disease Control and Prevention.Diabetic ketoacidosis.
Cleveland Clinic.Brittle diabetes.
Thewjitcharoen Y, Viriyautsahakul V, Sasijaroenrat N, et al.Celiac disease as a cause of anemia and brittle diabetes in type 1 diabetes mellitus.J ASEAN Fed Endocr Soc. 2021;36(2):227-230. doi:10.15605/jafes.036.02.19
Feldman EL, Callaghan BC, Pop-Busui R, et al.Diabetic neuropathy.Nat Rev Dis Primers. 2019;5(1):42. doi:10.1038/s41572-019-0097-9
UpToDate.Approach to the adult with brittle diabetes or high glucose variability.
Hirsch I, Gaudini L.A new look at brittle diabetes.J Diabetes Complications. 2021;35(1):1-8. doi:10.1016/j.jdiacomp.2020.107646
Liu J, Zhou L, Sun L, et al.Association between intestinalPrevotella copriabundance and glycemic fluctuation in patients with brittle diabetes.Diabetes Metabol Syndr Obes. 2023;2023(16):1613-1621. doi:10.2147/DMSO.S412872
Harvey JN.Psychosocial interventions for the diabetic patient.Diabetes Metab Syndr Obes. 2015;8:29-43. doi:10.2147/DMSO.S44352
National Institute of Mental Health.Mental health medications.
Singh Kochar I, Jain R.Pancreas transplant in type 1 diabetes mellitus: the emerging role of islet cell transplant.Ann Pediatr Endocrinol Metab. 2021;26(2):86-91. doi:10.6065/apem.2142012.006
National Institute of Diabetes and Digestive and Kidney Diseases.Pancreatic islet transplantation.
Food and Drug Administration.FDA clears new insulin pump and algorithm-based software to support enhanced automatic insulin delivery.
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