Brittle diabetes is a rare condition, affecting about three out of every 1,000 people who take insulin for diabetes.

What Are The Causes And Treatment Of Brittle Diabetes?

Brittle diabetes is the term physicians use to describe diabetes that is particularly difficult to manage. Brittle diabetes is also known as “labile” diabetes. Brittle and labile are two terms that say “unstable” or “easily modified.” 

What Are The Causes And Treatment Of Brittle Diabetes?

Characteristics of Brittle diabetes:

It is characterized by large fluctuations or “swings” in blood glucose levels, which can easily change from extremely elevated to too very low. These episodes are unpredictable and can have a negative impact on one’s quality of life.

They can necessitate repeated or prolonged hospitalizations, and they may turn out to be fatal.

Patients with brittle diabetes mellitus or also known as labile diabetes, are most likely to have regular, severe fluctuations in blood glucose levels, which can lead to hyperglycemia or hypoglycemia. 


The most vulnerable are those with type 1 diabetes. While many patients with type 1 diabetes have hypoglycemia, only a small few have “brittle” blood glucose swings.

People with type 2 diabetes who have been diagnosed for a long time can also struggle with blood glucose regulation, but only a small percentage of them experience these extreme swings.

Moreover, some studies suggest women as more likely to be affected than men.

Might be fatal

Frequent low blood sugar may contribute to hypoglycemic unawareness, which may exacerbate the disorder. Maintaining strong diabetes management for at least a few weeks will help you regain hypoglycemic sensitivity.

Continuous glucose sensors and insulin pumps are examples of new technology that may help with monitoring.

Causes of Brittle diabetes

  • Emotional discomfort
  • Eating disorders
  • Substance abuse 
  • Alcohol abuse
  • Malabsorption
  • Gastroparesis,
  • Celiac disease 

Signs and symptoms

Blood sugar < 70mg/dl

  • Feeling shaky
  • Nervousness or anxiety
  • Sweating, chills
  • Irritability
  • Confusion
  • Fast heart rate
  • Dizziness
  • Nausea
  • Blurred vision
  • Weakness
  • Headache
  • Seizures
  • Blurred vision
  • Weakness
  • Headache
  • Seizures
  • Unconsciousness

Blood sugar >200mg/dl

  • Frequent urination
  • Extreme thirst
  • Blurred vision
  • Fatigue
  • Headache 

Common sign and symptoms of people with brittle type 1 diabetes:

  • Unpredictable and abrupt fluctuations in blood glucose levels with no apparent cause 
  • Very high and very low blood sugar levels on a regular basis 
  • Ketoacidosis and/or serious hypoglycemia are more likely and occur more often.

Identifying the factor

Factors that may be causing brittle diabetes may assist your health care team in developing treatment plans to resolve the causes. Your healthcare staff will assist you in determining which conditions could be causing difficult-to-control blood sugar levels.

  • Stress, depression, and other psychological conditions are often linked to brittle diabetes. Acute and transient insulin resistance can be caused by stress. This means that the body does not react to insulin, and the condition will emerge and vanish suddenly. When it comes to judging insulin doses, this may be a real obstacle.
  • Autonomic neuropathy, or nerve dysfunction that affects organ function, may cause issues with delayed stomach emptying ( gastroparesis ), as well as intestinal function. It’s difficult to decide when or how much insulin to provide when you don’t know when the meal will be digested. Since unpredictable increases and declines in sugar levels are one of the biggest issues with brittle diabetes, a low-carbohydrate diet may help to minimize the large fluctuations in blood glucose, making rapid rises and drops less possible and serious.


Since one of the key issues with brittle diabetes is the unpredictability of sugar levels, a low-carbohydrate diet may help to minimize the large fluctuations of blood glucose levels, make rapid increases, and fall less probable and serious.

If the cause is autonomic neuropathy, the diabetes team will be able to provide you with guidance about how to properly administer insulin doses. 

If you think you have a psychological problem, your doctor will be able to help you deal with it.

Talking therapy and mindfulness-based therapies are two types of approaches that have been shown to be effective in treating issues such as stress, anxiety, and depression.

New diabetic therapies have made it possible for most people to keep their blood glucose levels under check.

Artificial pancreas technology is currently undergoing clinical trials with the aim of assisting people with type 1 diabetes in further managing their blood glucose levels.

The US Food and Drug Administration approved a hybrid artificial pancreas prototype in 2016, an electronic device that allows consumers to change insulin intake at mealtimes. Islet cell transplantation has also demonstrated positive effects in restoring blood glucose balance, according to NIH-funded reports.