Brittle diabetes is a severe form of diabetes. Also called labile diabetes, this condition causes unpredictable swings in blood sugar (glucose) levels. These swings can affect your quality of life and even lead to hospitalization.

Thanks to advances in diabetes management, this condition is uncommon. However, it can still occur in people with diabetes. In some cases, it’s a sign that your blood sugar is poorly managed. The best way to prevent brittle diabetes is to follow a diabetes care plan created by your doctor.

The biggest risk factor for brittle diabetes is having type 1 diabetes. Brittle diabetes occurs rarely in people with type 2 diabetes. Some doctors classify it as a complication of diabetes, while others consider it a subtype of type 1 diabetes.

Type 1 diabetes is characterized by blood sugar levels that fluctuate between high and low (hyperglycemia and hypoglycemia). This results in a dangerous “roller coaster” effect. The fluctuation in glucose levels can be rapid and unpredictable, causing dramatic symptoms.

In addition to having type 1 diabetes, your risk of brittle diabetes is higher if you:

Frequent symptoms of low or high blood glucose levels are common indicators of brittle diabetes. People with type 1 or type 2 diabetes can experience these symptoms when their blood sugar levels are off. However, with brittle diabetes, these symptoms occur and change frequently and without warning.

Symptoms of very low blood sugar levels include:

Symptoms of high blood glucose levels can include:

Balancing your blood sugar levels is the primary way to manage this condition. Tools that can help you do this include:

Subcutaneous insulin pump

The main goal for people with brittle diabetes is to better match the amount of insulin they get to how much they need at a given time. That’s where the subcutaneous insulin pump comes in. It’s the most effective tool for controlling brittle diabetes.

You carry this small pump in your belt or pocket. The pump is attached to a narrow plastic tube that is connected to a needle. You insert the needle under your skin. You wear the system 24 hours a day, and it continuously pumps insulin into your body. It helps keep your insulin levels steady, which in turn helps keep your glucose levels on a more even keel.

Continuous glucose monitoring

Typical diabetes management involves regular testing of your blood to check your glucose levels, often several times each day. With brittle diabetes, that may not be often enough to keep your glucose levels under control.

With continuous glucose monitoring (CGM), a sensor is placed under your skin. This sensor constantly detects glucose levels in your tissues and can alert you when these levels get too high or too low. This allows you to treat your blood sugar issues right away.

If you think a CGM system might work well for you, talk to your doctor to find out more.

Other treatment options

Brittle diabetes often responds positively to careful management. However, some people with the condition still have severe blood sugar fluctuations despite treatment. In rare cases, these people may need a pancreas transplant.

Your pancreas releases insulin in response to glucose in your bloodstream. The insulin instructs your body’s cells to take glucose from your blood so the cells can use it for energy.

If your pancreas doesn’t function correctly, your body won’t be able to process glucose properly. A study published in the journal Diabetes Care showed that pancreas transplants have high success rates in managing brittle diabetes.

Other treatments are in development. For instance, an artificial pancreas is currently in clinical trials in a collaborative project between the Harvard School of Applied Engineering and the University of Virginia. An artificial pancreas is a medical system that makes it unnecessary for you to manually manage your glucose monitoring and insulin injection. In 2016, the Food and Drug Administration (FDA) approved a “hybrid closed-loop system” artificial pancreas that tests your glucose level every five minutes, 24 hours a day, automatically supplying you insulin as needed.

Brittle diabetes itself isn’t fatal, and in most cases you and your doctor can manage it successfully. However, severe changes in blood sugar can lead to hospitalization because of the risk of diabetic coma. Also, over time, this condition can lead to other complications, such as:

The best way to avoid these problems is prevention of brittle diabetes.

Although brittle diabetes is rare, it’s still important to take preventive measures against it. This is especially true if you have any of the risk factors listed above.

To help prevent brittle diabetes, your doctor might recommend that you:

  • maintain a healthy weight
  • see a therapist to manage stress
  • obtain general diabetes education
  • see an endocrinologist (a doctor who specializes in diabetes and hormonal imbalances)

Brittle diabetes is uncommon, but if you have type 1 diabetes, you should be aware of its possible causes and symptoms. You should also know that monitoring and managing your blood sugar levels is the best way to prevent all diabetes complications, including brittle diabetes.

If you have questions about how to manage your diabetes, talk to your doctor. They can help you understand more about your condition and advise you on how to stick to your care plan. Working with your doctor, you can learn to manage — or prevent — brittle diabetes.