Uncontrolled type 1 diabetes accompanied by unpredictable blood glucose fluctuations (extremes of blood glucose peaks and valleys) is called brittle diabetes. It's a rare disease (with less than 1% of the people with insulin-dependent diabetes getting it) characterized by blood glucose lability (having the quality of being labile and hence also called labile diabetes) which may require frequent hospitalization. If you are diagnosed with brittle diabetes you are likely to have either low blood sugar (hypoglycemia) or high blood sugar (hyperglycemia) with the latter being more predominant and extreme in most cases. Significantly, these fluctuations in blood glucose levels happen for no apparent reason.
Young and overweight women are more likely to be affected with brittle diabetes and people in the age group of 15-30 are the most susceptible. People with psychological problems are more likely to get brittle diabetes as well, precisely because their own psychological problems could prevent them from taking proper medicines and a balanced diet - the prerequisites required for maintaining a normal blood sugar level.
In practical terms, if you have brittle diabetes your blood glucose level will fluctuate like a yoyo. It could be 500 just a while back and then slip to say 90. It could again bounce back to say 400 after a little while. In other words your blood glucose level would be constantly roller-coasting and you wouldn't know the reason why this was happening.
Causes
Several factors contribute to the cause of brittle diabetes. It could be any of the following namely:
Drug interactions
Problems with the absorption of insulin: Some of the reasons attributed to this are; subcutaneous insulin degradation; faulty and restrained hyperaemic response to insulin injection; and enhanced insulin clearance from the body. Any or all of these problems associated with absorption of insulin could cause brittle diabetes.
Hormonal effects: The hormonal response to stress is greater in people diagnosed with brittle diabetes than in other forms of diabetes, indicating possible hormonal malfunction in people with brittle diabetes.
Absorption problems in the GI tract and delayed stomach emptying or what is referred to as gastroperises: This could affect the absorption rates of food, glucose and insulin leading to brittle diabetes.
Recent research studies suggest that people suffering from anorexia nervosa (an eating cum psychological disorder) eventually end up getting brittle diabetes.
Symptoms
If you have brittle diabetes, the chances are you may experience depression and increased stress. Frequent hospitalization is a distinct possibility and consequently you may miss going to the workplace. All of this could contribute to more of psychological and emotional stress.
The major typical symptoms associated with brittle diabetes are weight gain around the waist and abdomen, palpitations and skin changes indicative of a dry and thinning look.
Treatment
If psychological issues are the cause of brittle diabetes, then that has to be corrected by psychotherapy or by trying to remove the possible cause of stress which the person may be experiencing. Perhaps shifting the patient to a specialty diabetes center or hospital along with persistent monitoring of blood, glucose and insulin will help reign in brittle diabetes.
Continuous use of insulin pump for controlling glucose levels may suit a patient whose brittle diabetes is caused by factors other than psychological. Supporting the patient and his family for effective management of diabetes is the key to the treatment of brittle diabetes.
One particular line of treatment for brittle diabetic patients is to administer combination therapy of insulin with glyburide. Pancreas transplant is an option for a patient with severe brittle diabetes although it is considered a high risk option only to be resorted to if other glucose controlling therapies fail.
