Brittle Diabetes

Brittle diabetes is a very dangerous condition and needs to be understood and managed carefully. It is also known as unstable diabetes or labile diabetes. The term “brittle” originated with Dr. Woodyatt in 1934. It described unexplained large changes in blood glucose concentration.

Most patients with this form of diabetes are females in their teens or 20s. There seems to be a second peak that occurs at 60 to 70 years of age. There is very little research dealing with diabetes in the elderly.

Brittle diabetes causes irregular and unpredictable hyperglycemia (high blood sugars). There is also serious hypoglycemia (low blood sugars). It usually refers to a form of type 1 diabetes. Recently, there are more cases of the elderly with type 2 diabetes classified as “brittle”.

It is so important to test your blood sugar levels and take your insulin regularly. You want to avoid a diabetic coma that can lead to death. Diabetic ketoacidosis occurs with high blood glucose and lack of insulin. The body starts to use fat tissues for energy. The acidic wastes can build up in your body and cause a coma.

Diabetes and the Family

The brittle diabetic is frequently hospitalized. They are absent from work and often have to contend with psychological problems. All of this puts emotional and financial stress on family members.

This type of diabetes is relatively rare. Less than 1% of patients with diabetes that is insulin-dependent go through this instability. People who are stressed or suffer from depression are at a higher risk.

Sometimes the depression can lead to neglect of diabetic issues. They stop measuring the blood glucose and do not faithfully take insulin. This leads to swings of hyperglycemia and hypoglycemia and hospitalization.

One small study documented that patients with this diabetes have a greater response to stress than those patients whose diabetes in not brittle. This hormonal connection may cause this diabetes.

You May Not Be Brittle

There are other explanations for swings in blood sugar levels instead of “brittle.” There is the dawn phenomenon and the Somogyi Effect. As part of a normal sleep cycle, our bodies prepare for waking up. Your body releases hormones and sugar to help you wake up. You may pick up on this during your morning blood tests.

The Somogyi Effect is named for a researcher from the 1930s. Your body is always looking for a balance. After you eat, your blood sugar can go up. You may take more insulin to counteract the rise. This will trigger a low and your liver will put out stored glucose. This will bring you back to a high level. You are only high because of the rebound from the low. You are not brittle – this is the Somogyi Effect.

Real brittle diabetics do not follow a pattern. If you are brittle, you will experience unpredictable, large swoops in blood sugars within a short period time.

Testing for Diabetes

In June 2009, an international committee recommended that testing for diabetes types include:

• Glycated hemoglobin (A1c) test. This blood test measures your average blood sugar level over the past two or three months. It measures the percent of blood sugar attached to your hemoglobin, the oxygen-carrying protein in your blood. An A1c level of 6.5% or higher indicates you have diabetes.
• Random blood sugar test. A blood sample taken at anytime with a level of 200 mg/dL or higher is diabetic.
• Fasting blood sugar test. A blood sample taken after an overnight fast with a glucose reading less than 100 mg/dL is normal. If it is above 126 mg/dL or higher, you are diabetic.

You should keep a record of your blood sugar numbers. Most blood glucose meters have a memory feature. When you visit your doctor, it’s helpful to have a printed list of your numbers with the time of day. That way your diabetes can be analyzed.

Conclusion

We have explained brittle diabetes and possible explanations for swings in blood sugar levels. We also explained the three types of testing for diabetes. Elsewhere on this web site is information about types of diabetes and a food guide for diabetics. Let us know if you have any questions or comments.

Margaret Stenerson
March 6, 2010