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Johns Hopkins Health Alert

The Challenge of “Brittle” Diabetes

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An important goal of diabetes treatment is tight glucose control, which means keeping your blood glucose level as close to normal as possible. But staying in good control is difficult, especially for people with “brittle” diabetes. What does this old-fashioned term mean?

"Brittle" diabetes is sometimes used to describe the condition of patients who have frequent swings in blood glucose levels from very high to very low. It's natural for blood glucose to rise and fall during the day in response to meals, exercise, and other influences. However, people with brittle diabetes (sometimes called labile diabetes) often experience drops and peaks in blood glucose so severe that they require medical attention.

Brittle diabetes is more common in people with type 1 diabetes, but it also can occur in type 2 diabetes. Certain medical conditions may be linked to brittle diabetes, such as gastroparesis (a delay in stomach emptying, which interferes with the timing of carbohydrate absorption after meals) and some endocrine disorders, such as hypothyroidism.

Most often, though, brittle diabetes is a sign that the person is struggling with the inherent challenge of replacing the pancreas's finely tuned production of insulin with the cruder method of injecting this essential hormone.

There are no easy answers for overcoming brittle diabetes. However, gaining control is often a matter of paying closer attention to the daily requirements of managing blood glucose. For example, are you accurately matching your insulin dose to the amount of carbohydrates you eat at each meal? Oftentimes, people find that heeding these kinds of finer details helps minimize the highs and lows.

Posted in Diabetes on August 12, 2010
Reviewed January 2011

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Health Alerts registered users may post comments and share experiences here at their own discretion. We regret that questions on individual health concerns to the Johns Hopkins editors cannot be answered in this space.

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I find it hard to believe that NORD, NIH's GARD, Ranker, WHO, and the IDF have yet to recognize brittle or labile diabetes as a rare Type 1 disorder. Despite the fact that the literature is replete with articles in recognized medical journals on the difference between standard type 1(which affects 3 million people in the USA) and brittle diabetes that effects less than 9,000 citizens, we still see a reluctance to formally recognize this group as an orphan disease or disorder. Generally, the tendency is to dismiss this group as being non-compliant until, under controlled environmental conditions, physicians realize that despite their best efforts at playing the balancing act between bolus and basal insulin, this group fails to respond according to the standard type 1 playbook. The Brittle Diabetes Foundation was formed to focus attention on the fact that brittleness has a cause and when treated - some 50% of brittle diabetic patients revert back to being a standard type 1 diabetic. More attention should be provided to individuals diagnosed as brittle and that should begin by at least recognizing the uniqueness of this illness.

Posted by: sorge | June 30, 2013 4:01 PM

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