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Brittle Diabetes

Last updated May 5, 2018

Approved by: Krish Tangella MD, MBA, FCAP

Brittle Diabetes is a term that is sometimes used to describe hard-to-control diabetes (also called Labile Diabetes). It is characterized by wide variations or “swings” in blood glucose (sugar) in which blood glucose levels can quickly move from too high (hyperglycemia) to too low (hypoglycemia).

What are the other Names for this Condition? (Also known as/Synonyms)

  • Brittle Diabetes Mellitus
  • Brittle Type 1 Diabetes
  • Labile Diabetes

What is Brittle Diabetes? (Definition/Background Information)

  • Brittle Diabetes is a term that is sometimes used to describe hard-to-control diabetes (also called Labile Diabetes). It is characterized by wide variations or “swings” in blood glucose (sugar) in which blood glucose levels can quickly move from too high (hyperglycemia) to too low (hypoglycemia)
  • These episodes are hard to predict and can disrupt quality of life. They can require frequent or lengthy hospitalizations and can be fatal
  • People with type 1 diabetes are at greatest risk. While many people with type 1 diabetes experience hypoglycemia, only a small proportion of people with type 1 diabetes experience the frequent blood glucose swings described as “brittle” 
  • People with long-standing type 2 diabetes may also have difficulty controlling blood glucose, but few have these frequent swings 
  • People of any age with diabetes can be affected with these frequent ups and downs in blood glucose levels. Some research suggests that women may be affected more often than men
  • Frequent episodes of hypoglycemia can lead to hypoglycemic unawareness and make the condition worse

(Source: Brittle Diabetes; Genetic and Rare Disease Information Center (GARD) of National Center for Advancing Translational Science (NCATS), USA.)

Who gets Brittle Diabetes? (Age and Sex Distribution)

  • Brittle Diabetes is a rare disorder affecting individuals with diabetes (usually type 1 diabetes)
  • The presentation of symptoms may occur at any age
  • Although both geneders may get affected, females are reported to be affected at a higher frequency
  • Worldwide, individuals of all racial and ethnic groups may be affected

What are the Risk Factors for Brittle Diabetes? (Predisposing Factors)

The risk factors for Brittle Diabetes include:

  • Type 1 diabetes, specifically in combination with the following factors:
    • Non-compliance with treatment
    • Poor glycemic control
    • Female gender
  • Prolonged type 2 diabetes (with the above factors)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Brittle Diabetes? (Etiology)

Brittle Diabetes may be caused by poor glycemic control, which can result from any of the following factors:

  • Not taking medications as prescribed (non-compliance)
  • A condition called “gastroperesis,” or slow emptying of the stomach. This may lead to reduced insulin absorption into the bloodstream
  • Intestinal malabsorption
  • Celiac disease
  • Increased sensitivity to insulin
  • Excessive stress
  • Depression

What are the Signs and Symptoms of Brittle Diabetes?

The signs and symptoms of Brittle Diabates may fluctuate, depending on the glycemic status of the affected individual.

The signs and symptoms of Brittle Diabetes caused by hyperglycemia:

  • Thirst despite excessive drinking of water
  • Excessive urination
  • Weakness and severe fatigue
  • Confusion

The signs and symptoms of Brittle Diabetes caused by hypoglycemia:

  • Blurred vision
  • Anxiety, confusion, or irritability
  • Fatigue
  • Heart palpitations
  • Headaches
  • Clammy skin, excessive sweating
  • Shakiness/trembling, loss of coordination
  • Numbness around the mouth
  • Dilated pupils

How is Brittle Diabetes Diagnosed?

Brittle Diabetes is diagnosed on the basis of the following information:

  • Complete physical examination
  • Thorough medical history evaluation
  • Assessment of signs and symptoms
  • Laboratory tests
  • Imaging studies
  • Biopsy studies, if necessary

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Brittle Diabetes?

The complications of Brittle Diabetes may include those resulting from hypoglycemia as well as hyperglycemia:

  • Hypoglycemia-related complications of Brittle Diabates:
    • Hypoglycemic unawareness
    • Loss of consciousness
    • Seizure
    • Risk of falls and injury due to seizures
  • Hyperglycemia-related complications of Brittle Diabetes:
    • Progressive weakness
    • Confusion
    • Progression to ketoacidosis, which can cause accumulation of toxic ketones in the blood
    • Kidney failure
    • Seizures
    • Risk of falls and injury due to seizures
    • Coma

The following complications may also occur in Brittle Diabetes:

  • Frequent hospital visits; long hospital stays
  • Reduced quality of life

Complications may occur with or without treatment, and in some cases, due to treatment also.

How is Brittle Diabetes Treated?

The treatment for Brittle Diabates may involve:

  • Ensuring compliance by affected individuals, to enable good glycemic control
  • Identifying and rectifying pre-existing conditions that can lead to Brittle Diabetes in diabetic individuals
  • Techniques to combat stress and address depression
  • Hospitalizations to stabilize blood glucose levels

How can Brittle Diabetes be Prevented?

In some cases, Brittle Diabetes may be prevented by considering the following factors:

  • Following a treatment regimen, in order to maintain good glycemic index
  • Regular physical activity
  • Avoiding exercise on an empty stomach
  • Eating meals on time (small meals at regular intervals, without lengthy gaps between large meals)
  • Avoiding refined carbohydrate products in meals
  • Limiting alcohol and caffeine consumption
  • Seeking prompt medical attention for conditions that may pre-dispose an individual to Brittle Diabetes
  • Regular medical screening at periodic intervals with tests and physical examinations

Active research is currently being performed to explore the possibilities for treatment and prevention of disorders such as Brittle Diabetes.

What is the Prognosis of Brittle Diabetes? (Outcomes/Resolutions)

  • The prognosis of Brittle Diabetes is guarded, owing to uncontrolled blood glucose levels and their wide variations
  • A proper diagnosis and prompt treatment may aid in bringing the blood glucose levels under control
  • However, the unpredictable nature of Brittle Diabates and complications, such as seizures or coma, may result in fatalities

Additional and Relevant Useful Information for Brittle Diabetes:

The following DoveMed website links are useful resources for additional information:



What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: May 5, 2018
Last updated: May 5, 2018