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If you have diabetes, you must be doing everything to manage it. You may be following a healthy diet with no sugar, taking insulin when needed, and staying active. But there are times when it gets really hard to manage diabetes and this can affect the quality of life. That’s called brittle diabetes or labile diabetes, which is a severe form of this health condition. It is not an official medical diagnosis but a way to describe diabetes that is hard to manage. Characterised by frequent and unpredictable fluctuations in blood glucose levels, it can occur in people with type 1 or type 2 diabetes.
It is a common term used by doctors to describe hard to manage diabetes. “In case of brittle diabetes, blood glucose levels fluctuate unpredictably, causing extreme highs (hyperglycemia) and lows (hypoglycemia) despite the use of insulin and other diabetes management strategies,” shares endocrinologist and diabetologist Dr Piyush Lodha.
Back in 1934, American physician R.T. Woodyatt used the term for the first time to describe people with unexplained changes in blood glucose levels. Since then, the definition of brittle diabetes has evolved. Now, doctors use it to describe diabetes in a person whose life is constantly affected by hypoglycemia or hyperglycemia episodes, as per research published in the Journal Of Diabetes And Its Complications in 2020.
It is common in people with type 1 or type 2 diabetes complicated by severe insulin deficiency. About 12 out of every 10,000 adults with diabetes have it, according to research published in the Diabetes, Metabolic Syndrome and Obesity journal in 2023.
As for the age, it may affect elderly people but the peak age-group for brittle diabetes is 15 to 30, according to research published in the Journal Of the Royal Society of Medicine in 2001.
The primary symptom of brittle diabetes is erratic blood glucose levels, which can cause both low blood sugar and high blood sugar.
The exact cause of brittle diabetes is not clear, but a few factors can contribute to it:
In type 1 diabetes, the immune system destroys insulin-producing beta cells in the pancreas, making insulin administration essential. “In case of type 2 diabetes, the body becomes resistant to insulin. Both of these issues can cause fluctuations in blood glucose levels,” says Dr Lodha.
Stress-related hormones such as cortisol, adrenaline, and growth hormone can affect insulin sensitivity, leading to unpredictable blood sugar levels. For example, an illness can cause blood sugar levels to rise rapidly, even in well-controlled diabetics.
Anxiety, depression, and stress can exacerbate blood sugar instability in people with diabetes. “Mental stress can lead to hormonal changes that interfere with insulin function, causing wild fluctuations in blood glucose levels,” says the expert.
An autoimmune condition like celiac disease, that occurs when you eat gluten, can contribute to blood sugar instability. During a 2021 study, published in the Journal Of The ASEAN Federation Of Endocrine Societies, researchers found that people experiencing brittle diabetes may be due to untreated celiac disease.
“Diagnosing brittle diabetes typically involves monitoring blood glucose patterns and assessing the frequency of extreme fluctuations,” says the expert.
“Treatment for brittle diabetes focuses on stabilising blood glucose levels and reducing the severity of blood sugar fluctuations,” says Dr Lodha. The following are common treatment strategies:
Close monitoring and adjustments to insulin dosage are essential for managing brittle diabetes. “Some people may benefit from insulin pumps or continuous glucose monitoring systems to provide more precise control,” says the expert.
Regular blood sugar checks are important for people with diabetes. They are critical to identifying and addressing fluctuations before they become dangerous. Some people may need to check their blood sugar levels several times a day, including overnight.
Part of brittle diabetes treatment is managing mental stress. “Counseling, therapy or stress management techniques may help to cope with the psychological aspects of brittle diabetes, which can contribute to blood sugar instability,” says the expert.
People with underlying conditions like celiac disease may be told to manage them. In case of celiac disease, going for a gluten-free diet is the best way to manage it. So, staying away from wheat, barley, semolina, and other foods with gluten will be beneficial.
Pancreas, a gland in the abdomen, releases insulin as a response to glucose in the bloodstream. The insulin then notifies the cells in the body to take glucose from the blood. Then the body cells use it for energy production. The pancreas needs to function properly otherwise the body won’t be able to process glucose in the correct manner. A 2013 study, published in the Diabetes Care journal, showed that pancreas transplants have high success rates in the management of brittle diabetes.
A consistent, balanced diet and regular physical activity can help maintain stable blood sugar. “Choose foods like whole grains, vegetables, fruits, and legumes,” says the expert. Working with a registered dietitian and an exercise expert can turn out to be beneficial.
Brittle diabetes is characterised by extreme and unpredictable swings in blood glucose levels. It can be managed with careful attention to insulin therapy, diet, emotional well-being, and regular monitoring.
Brittle diabetes is not more common in elderly people, but older adults with diabetes may face more challenges managing blood sugar. They may experience more difficulty managing brittle diabetes due to factors like reduced kidney function, slower metabolism, medication side effects, and the presence of multiple chronic health conditions.
Brittle diabetes itself is not inherited, but there is a genetic component to type 1 diabetes, which is the more common form associated with brittle diabetes. Individuals with a family history of type 1 diabetes may have a higher risk of developing it. Certain genetic conditions or predispositions may also make a person more prone to unstable blood sugar levels, but brittle diabetes itself is not directly passed down through generations.
It is a chronic condition that requires lifelong management. While the extreme fluctuations in blood sugar cannot be entirely eliminated, they can be controlled through careful monitoring, insulin adjustments, a balanced diet, and emotional support. With proper treatment, many people with brittle diabetes can achieve more stable blood sugar levels and reduce the risk of complications.
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