Brittle Diabetes (Labile Diabetes)
Brittle diabetes mellitus (or labile diabetes) is a term used to describe particularly hard to control type 1 diabetes.
How does brittle diabetes develop and what is it associated with?
Brittle diabetes has a number of potential causes.
It can be caused by absorption problems in the intestines. This includes delayed stomach emptying, drug interactions, insulin absorption issues and malfunctioning hormones.
Severely low blood sugar levels may also create thyroid and adrenal gland problems.
Gastroperesis, delayed stomach emptying, can affect the rate at which food, glucose and insulin is absorbed into the bloodstream.
Is brittle diabetes different from stable diabetes?
All people with diabetes will a certain level of blood glucose level fluctuation. However, when these shifts are not extreme or over-frequent they do not impair the ability to lead a normal life.
With brittle diabetes, however, the fluctuations are more serious and tend to result in frequent hospital visits, interruption to employment and can often contribute to psychological issues such as stress.
Life expectancy with brittle diabetes
The life expectancy for someone with brittle diabetes is no different to someone who has type 1 or type 2 diabetes.
In fact, brittle diabetes can also be described poorly controlled type 2 diabetes.
Is brittle diabetes common?
Brittle diabetes is rare but serious. Around 3 in 1,000 people with type 1 diabetes mellitus will develop brittle diabetes.
Will I get brittle diabetes?
Those people suffering from psychological problems, including stress and depression, face a greater risk of developing brittle diabetes. This can be as simple as psychological problems causing neglect of diabetes care (such as stopping eating healthily, taking medication or exercising regularly).
Blood sugar control quickly becomes less regular, and imbalances in the metabolism can exacerbate this.
Furthermore, psychological problems can then become worse, causing a symbiotic cycle which reinforces brittle diabetes.
Brittle diabetes is most likely to affect women who are overweight, between the ages of 15 and 30.
How is brittle diabetes treated?
The most effective treatment for brittle diabetes is to identify and correct underlying physical or psychological problems. Glucose instability is often able to be tracked using blood tests.
Often treatment seeks to address behavioural, psychological or environmental causes. This can be a lengthy and difficult process of treatment.
Treatment may involve trying to lessen stress, and psychotherapy has also proven to be effective in the treatment of brittle diabetes.
Caring for brittle diabetes
Sometimes, a completely fresh start in diabetes care is needed to break the brittle diabetes cycle.
Brittle diabetes treatment may sometimes require a long stay in hospital with monitoring of food, blood glucose levels and insulin.
Furthermore, physical brittle diabetes diagnosis may require insulin pump therapy to control blood glucose levels.
Islet and pancreas transplants
There may even be a case for islet transplants or even pancreas transplant. However, this therapy is at an early stage, and includes its own risks.
Healthcare professionals play a crucial role in treating brittle diabetes.
Patients require close supervision, with the diabetes care team making sure that the patient gets all of the relevant information and education.
Support for the patient themselves and their family and friends are an essential part of brittle diabetes management.