Brittle diabetes, a term commonly associated with erratic blood sugar levels in individuals with diabetes, is a rare and challenging condition. While diabetes typically refers to the body’s inability to regulate blood sugar (glucose) effectively, brittle diabetes is marked by extreme and unpredictable fluctuations in glucose levels, making it exceptionally difficult to manage.
Yar Pye, M.D., medical director of the Family Physician Family Health Center at NYU Langone in New York City, explains, “Brittle diabetes, also called labile diabetes, refers to a form of diabetes where blood sugar levels fluctuate dramatically, often beyond the control of conventional treatment methods.”
Although the term “brittle diabetes” is widely used, it is not an official classification recognized by either the American Diabetes Association (ADA) or the World Health Organization (WHO). It is a descriptive term and is typically found in individuals with type 1 diabetes or those with severely insulin-deficient type 2 diabetes. Notably, the condition affects only a small subset of people, estimated to be about three in every 1,000 individuals with type 1 diabetes.
What Triggers Brittle Diabetes?
The causes behind brittle diabetes are complex and multifaceted. Dr. Pye emphasizes that multiple factors contribute to the condition, including:
Hormonal Imbalances: Conditions such as acromegaly, Cushing’s syndrome, pheochromocytoma, and thyrotoxicosis can lead to insulin resistance, causing blood sugar levels to rise uncontrollably.
Gastrointestinal Issues: Disorders like gastroparesis, untreated Addison’s disease, and untreated celiac disease can impair nutrient absorption, contributing to frequent low blood sugar episodes.
Medications: Long-term use of corticosteroids is known to worsen blood sugar management and may lead to brittle diabetes.
Mental Health: Psychological factors, such as depression or eating disorders (including anorexia, bulimia, or diabulimia), can make it difficult for individuals to adhere to diabetes management protocols, exacerbating blood sugar instability.
Stress: Emotional stress is another contributor, making blood sugar regulation even more challenging.
Key Symptoms of Brittle Diabetes
Patients with brittle diabetes often experience severe swings in blood sugar levels, which can occur quickly and unpredictably. Dr. Pye elaborates, “Despite efforts to regulate their condition, individuals with brittle diabetes can experience extreme fluctuations in blood glucose, ranging from very high to very low levels in a short period.”
The frequent changes in blood sugar levels lead to symptoms of both hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar). Dr. Joseph E. Barrera, an endocrinologist at Providence Mission Hospital in Orange County, CA, explains, “Hyperglycemia may not cause noticeable symptoms, but hypoglycemia can lead to sweating, shakiness, confusion, or even a loss of consciousness if not addressed promptly.”
A Challenging Path for Diabetes Management
Brittle diabetes remains a rare and difficult condition, but ongoing research and awareness are crucial to improving the quality of life for those affected. Treatment requires a multifaceted approach that may involve hormonal therapy, adjusting medications, managing mental health conditions, and addressing external stressors to stabilize blood glucose levels. Understanding the causes and symptoms is key to effectively managing brittle diabetes and minimizing its impact on daily life.
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