How to control brittle diabetes – the kind that is difficult to control

For most people living with diabetes, managing blood sugar is about routine, eating right, taking insulin or medicines on time, and staying active. But for some, blood sugar levels refuse to cooperate despite doing everything by the book. This condition is known as brittle diabetes, or labile diabetes, and it can make everyday life exhausting and unpredictable. Though not an official medical diagnosis, brittle diabetes is a term doctors use to describe diabetes that is extremely difficult to control. It is characterised by sudden and frequent fluctuations between very high and dangerously low blood glucose levels.

Endocrinologist and diabetologist Dr Piyush Lodha tells Health Shots that these fluctuations can significantly affect quality of life, often leading to repeated hospital visits, anxiety and physical fatigue. Understanding why this happens is the first step toward better management.

What is brittle diabetes?

Brittle diabetes refers to diabetes, most commonly type 1, but sometimes type 2, that is unusually unstable. “In brittle diabetes, blood glucose levels fluctuate unpredictably, causing extreme highs and lows despite proper insulin use and lifestyle measures,” explains Dr Lodha. The term was first introduced in 1934 and has since been used to describe cases in which daily life is repeatedly disrupted by hypoglycemia or hyperglycemia.

Brittle diabetes is relatively rare but serious. Research published in Diabetes, Metabolic Syndrome and Obesity (2023) suggests that about 12 out of every 10,000 adults with diabetes experience this condition. While it can affect older adults, studies show it is most commonly seen in younger people aged 15 to 30 years, according to findings in the Journal of the Royal Society of Medicine.

Symptoms to watch out for

The main sign of brittle diabetes is erratic blood sugar. Low blood sugar may cause shaking, sweating, confusion, dizziness, mood changes, or even fainting and seizures in severe cases. High blood sugar, on the other hand, can lead to excessive thirst, frequent urination, fatigue, dry skin, blurry vision and nausea. These symptoms may appear suddenly and without an obvious trigger.

What are the hidden triggers of blood sugar fluctuations?

If you are following your plan but your numbers are still haywire, an underlying condition might be to blame:

1. Digestive tissues: Conditions like Gastroparesis (delayed stomach emptying) or Celiac disease make nutrient absorption unpredictable, causing insulin and food to mismatch in the bloodstream.
2. Hormonal surges: Stress-related hormones like cortisol and adrenaline can interfere with insulin function, causing rapid, unexpected rises in glucose.
3. Psychological stress: Severe anxiety or depression can physically alter how your body processes sugar, making mental health support a critical part of treatment.

Treatment and management options

While brittle diabetes is challenging, modern medical advances are helping patients find stability:

1. Continuous glucose monitors (CGM): These devices provide real-time data, helping to catch a swing before it becomes an emergency.
2. Insulin pumps: These allow for more precise, minute-by-minute insulin delivery compared to traditional injections.
3. Pancreas transplants: In severe, life-threatening cases, a transplant may be considered. Research in diabetes care reports high success rates in stabilising blood glucose levels with this procedure.

In addition, a consistent diet rich in whole grains, vegetables, fruits, and legumes, combined with regular physical activity, can support better glycemic control.

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