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What is Brittle Diabetes, and How Can You Manage It?

Brittle diabetes is a severe, rare form of type 1 diabetes in which blood sugar levels are very hard to control, causing disruptions in daily life. It can also occur very rarely in people with type 2 diabetes. 

A person with brittle diabetes will experience massive fluctuations in blood sugar levels. They are at higher risk for dangerous lows, as well as diabetic ketoacidosis and diabetic coma. Other complications of brittle diabetes include thyroid disease, adrenal gland problems, depression, and weight gain. 

The standard A1C test is not an accurate tool for those with brittle diabetes. Instead, a more targeted and in-depth approach at looking at whole body health is needed.

Who gets brittle diabetes?

Anyone can develop brittle diabetes, but it seems to be more common in females. In addition, you are more likely to develop brittle diabetes if you:

  • Are overweight
  • Have a hormonal imbalance
  • Have hypothyroidism
  • Are a young adult in your 20s or 30s
  • Undergo frequent stress
  • Have depression
  • Have celiac disease or gastroparesis (slow emptying of the stomach)
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Underlying causes of brittle diabetes

In most cases, there is something else going on in the body that’s causing brittle diabetes. These can be factors such as:

  • Psychological issues such as depression, stress, or others
  • Nerve damage that causes digestive issues like gastroparesis
  • Problems with insulin absorption
  • Drug interactions

Other possible causes include celiac disease, vitamin D deficiency, hypothyroidism, Cushing disease, cystic fibrosis, and scleroderma. 

Ways to treat brittle diabetes

It helps to get to the root of the problem in order to treat brittle diabetes. If it is gastroparesis or another problem causing it, that issue must be treated first. There are a few ways brittle diabetes might be managed, including:

  • Using a continuous glucose monitor (CGM) that detects your blood sugar levels at all times and alerts you to adjustments that need to be made in insulin. 
  • Using an insulin pump to keep blood sugar levels stable. With a subcutaneous pump, you receive insulin throughout the day. 
  • Eating a reduced carbohydrate diet in order to lessen the risk of severe highs and lows.
  • Having a pancreas transplant. In some cases pancreas transplants have been very successful at treating brittle diabetes. 
  • Using an artificial pancreas. This advanced system is still in clinical trials. The “hybrid closed loop system” can test your glucose throughout the day and automatically supply the amount of insulin you need.  

Since brittle diabetes has several complicating causes and symptoms, it is advised that people with the disease see a board-certified endocrinologist. In many cases, it is advised to also see a therapist to address the psychological aspects of the disease. For more information, visit the Brittle Diabetes Foundation’s website.