Brittle diabetes

Brittle diabetes, also known as unstable diabetes or labile diabetes, refers to a type of insulin-dependent diabetes characterized by dramatic and recurrent swings in glucose levels, often occurring for no apparent reason.
The result can be irregular and unpredictable hyperglycemias, frequently with ketosis, and sometimes serious hypoglycemias. Brittle diabetes occurs no more frequently than in 1% to 2% of diabetics.
Although brittle diabetes normally refers to a severe, uncontrolled form of type 1 diabetes, it can also describe poorly controlled type 2 diabetes.
Brittle diabetes usually affects type 1 diabetes patients between the ages of 15 to 30, but this condition is also evident in elderly people with type 1 or type 2 diabetes.
People who have undergone a total pancreatectomy often develop brittle diabetes.
Variations
Variations of brittle diabetes can include:
* Hypoglycemic instability. This is characterized by frequent and unpredictable low glucose levels (hypoglycemia).
* Mixed hypoglycemic and hyperglycemic instability, where the individual experiences unpredictable swings between high and low levels of the glucose.
* Diabetic ketoacidosis. High blood glucose and lack of insulin cause the body to use fat tissue for energy. This can cause diabetic coma from the resulting acidic wastes.
* Hyperosmolar hyperglycemic non-ketotic syndrome (HHNS), characterized by severe hyperglycemia and dehydration, can lead to diabetic coma.. This can occur in those whose diabetes has not yet been diagnosed.
Symptoms
Brittle diabetes does not follow a specific pattern. Depending upon whether or not it involves hypoglycemia, hyperglycemia or a combination of both, possible indicators may include unpredictable glucose in the morning, depression or other psychological issues, and the Somogyi effect (a hyperglycemic rebound after a period of low blood glucose)
Causes
The most common reason for glycemic instability in type 1 diabetes is because the counterregulatory function is also severely impaired by the autoimmune response that destroys the insulin-producing beta cells, leaving patients without the body's natural defenses to hypoglycemia (low blood glucose levels).

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