Brittle Diabetes

“Brittle Diabetes” is a term, which is used to describe patients with recurrent hypoglycaemic coma, and/ or recurrent ketoacidosis. There is dramatic recurrent instability in blood glucose levels, which often occur for no apparent reason. It is a relatively unusual condition.

It is often at the point at which the person’s life becomes unacceptably disrupted that the term “brittle” or “labile” is used, though the term and use of the term is not universally popular.

It is more likely to occur in Type1 diabetics, because of the complete lack of endogenous insulin production (occurring within the body). The common picture is that of young female patients.

The cause is usually unknown, though it can occur in certain identified cases, such as where there is a known infection, where there are other metabolic disturbances (such as hypothyroidism or Addison’s Disease, an adrenal gland disorder), or where there is an unpredictable delay in stomach emptying (“gastroparesis”). Hypoglycaemic unawareness may be a cause.

However, It is often believed that it is due to a management problem instead, where there may be an insulin regime which is not effective, inadequate background understanding of the condition by the patient, an imbalance of the levels of activity, diet and medication, stress, or psychosocial problems affecting behaviour.

Management is through a thorough review of all aspects of care (insulin control and feedback of level of control, dietary history, lifestyle history and any other relevant factors, such as undue stressors). The regimen may well need to be stricter and more closely monitored for a period of time.

A planned admission into hospital may be necessary for severe cases where every aspect of the condition and its management can be scrutinised and controlled.

It has been shown that psychotherapy and family therapy is useful in some cases.