For most people with diabetes, blood sugar can be managed with the right mix of medication, diet, exercise, and monitoring. But in some rare cases, blood glucose levels swing so unpredictably and severely that they become almost impossible to control. This condition is known as brittle diabetes — also called labile diabetes. But what exactly does brittle diabetes mean, who is affected, and how is it treated?

In this comprehensive guide, we’ll explore what brittle diabetes is, how it differs from other types of diabetes, its causes, symptoms, treatment options, and long-term outlook. We’ll also share lifestyle strategies and support resources to help manage this challenging condition.

What is brittle diabetes?

Brittle diabetes is a rare, severe form of type 1 diabetes characterized by dramatic and unpredictable swings in blood sugar levels. People with brittle diabetes may experience frequent episodes of hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar), often requiring hospitalization.

Unlike typical diabetes, brittle diabetes is resistant to standard management. Even with careful monitoring, small changes in diet, stress, or insulin doses can cause blood sugar to spiral out of control.

Who gets brittle diabetes?

Brittle diabetes is rare, affecting only about 1–2% of people with type 1 diabetes. It tends to:

• Occur more often in younger women (ages 20–30s).

• Appear in people with psychiatric conditions like depression or eating disorders.

• Affect individuals with gastroparesis (delayed stomach emptying), which complicates glucose management.
  
  

How brittle diabetes differs from typical diabetes

Most people with type 1 diabetes experience fluctuations in blood sugar, but they can usually manage them with insulin, diet, and exercise. In brittle diabetes:

• Blood sugar changes are severe, frequent, and unpredictable.

• Episodes may lead to repeated ER visits or hospitalizations.

• Quality of life is often significantly impacted.
  
  

Causes and risk factors

The exact cause of brittle diabetes is not fully understood, but several factors may contribute:

• Hormonal fluctuations: Especially in women of childbearing age.

• Mental health issues: Depression, anxiety, or stress can worsen glucose instability.

• Gastrointestinal problems: Conditions like gastroparesis delay food absorption, complicating insulin timing.

• Insulin absorption problems: Scar tissue from repeated injections may alter insulin effectiveness.

• Social and lifestyle factors: Irregular meals, poor sleep, or lack of support.
  
  

Symptoms of brittle diabetes

People with brittle diabetes may experience extreme highs and lows in short periods of time. Symptoms include:

Hyperglycemia (high blood sugar)

• Extreme thirst

• Frequent urination

• Fatigue

• Blurred vision

• Nausea or vomiting
  
  

Hypoglycemia (low blood sugar)

• Shaking or sweating

• Dizziness

• Hunger

• Irritability

• Confusion

• Seizures or loss of consciousness (severe cases)

These rapid changes can be exhausting physically and emotionally.

Complications of brittle diabetes

Because of the constant swings, brittle diabetes carries a higher risk of complications, including:

• Diabetic ketoacidosis (DKA) from uncontrolled hyperglycemia

• Severe hypoglycemia, which can be life-threatening

• Frequent hospitalizations

• Emotional distress, anxiety, and depression

• Long-term complications like kidney disease, vision loss, and neuropathy
  
  

How is brittle diabetes diagnosed?

There is no single test for brittle diabetes. Diagnosis usually involves:

• Reviewing a patient’s history of blood glucose instability.

• Documenting frequent hospitalizations or ER visits for blood sugar crises.

• Ruling out other possible causes of uncontrolled diabetes, such as poor medication adherence or misdiagnosis.
  
  

Treatment options for brittle diabetes

Treating brittle diabetes requires a multidisciplinary approach that combines medical, psychological, and lifestyle strategies.

Insulin therapy

• Insulin pumps can provide more precise dosing than injections.
  
  

• Continuous glucose monitors (CGMs) help track blood sugar trends in real-time.
  
  

• Some patients may benefit from hybrid closed-loop systems (artificial pancreas technology).
  
  

Medication adjustments

• Doctors may adjust insulin types and timing.
  
  

• Additional medications may be used to address related conditions (e.g., gastroparesis).
  
  

Mental health support

• Counseling or therapy for stress, anxiety, or depression.
  
  

• Support groups for people living with brittle diabetes.
  
  

Nutrition therapy

• Working with a registered dietitian to time meals, manage carbs, and avoid sudden glucose swings.
  
  

• Smaller, more frequent meals may help reduce spikes.
  
  

Surgical options

• In extreme cases, pancreas or islet cell transplantation may be considered.
  
  

Lifestyle strategies for managing brittle diabetes

While brittle diabetes is difficult to control, certain habits can help stabilize blood sugar:

• Regular meals: Avoid skipping or delaying food.

• Consistent sleep schedule: Poor sleep worsens glucose variability.

• Exercise carefully: Monitor blood sugar closely before, during, and after activity.

• Stress management: Meditation, yoga, or breathing techniques.

• Avoid alcohol and drugs: These can increase blood sugar swings.
  
  

Outlook for people with brittle diabetes

Brittle diabetes can be overwhelming, but advances in technology and treatment are improving outcomes. With access to insulin pumps, CGMs, and mental health care, many patients can achieve better stability. In some cases, transplantation provides long-term relief.

Support and resources

Living with brittle diabetes requires strong support systems:

• Endocrinologist: Specialized doctor for diabetes management.

• Diabetes educators: Help with day-to-day glucose management.

• Mental health professionals: Address stress, depression, or anxiety.

• Support groups: Online or in-person communities.
  
  

Takeaway

Brittle diabetes is a rare, severe form of type 1 diabetes marked by unpredictable swings in blood sugar that resist standard treatment. While challenging, it can be managed with a combination of advanced technology (like insulin pumps and CGMs), specialized medical care, nutrition planning, and emotional support. Mental health plays a critical role, and addressing underlying stress or depression is as important as adjusting insulin doses. For some, surgical options like pancreas transplantation may be necessary. Although brittle diabetes can significantly affect quality of life, support and evolving treatments are offering new hope.

Related Resources

• Type 1 Diabetes Life Expectancy – Long-term outlook for type 1 diabetes.

• Can Type 3 Diabetes Be Reversed? – What research says about reversal.

• Average Insulin Doses for Adults With Type 2 Diabetes – How insulin use differs by type.

References

Brittle Diabetes: What It Is, Causes, Symptoms & Treatment. (2023, August 23). Retrieved September 17, 2025, from Cleveland Clinic website: https://my.clevelandclinic.org/health/diseases/21499-brittle-diabetes 

Ellis, R. R. (2024, March 18). What Is Brittle Diabetes? Retrieved September 17, 2025, from WebMD website: https://www.webmd.com/diabetes/brittle-diabetes-all-about 

Hirsch, I. B., & Gaudiani, L. M. (2020). A new look at brittle diabetes. Journal of Diabetes and Its Complications, 35(1), 107646–107646. https://doi.org/10.1016/j.jdiacomp.2020.107646 

Hoskins, M. (2014, June 20). What Does Brittle Diabetes Mean? Retrieved September 17, 2025, from Healthline website: https://www.healthline.com/health/what-brittle-diabetes 

 

Frequently Asked Questions

Q: What is brittle diabetes?

A: It is a rare, severe form of type 1 diabetes with unpredictable blood sugar swings.

Q: What causes brittle diabetes?

A: Factors include stress, hormone changes, infections, and inconsistent insulin absorption.

Q: Is brittle diabetes life-threatening?

A: Yes, because extreme highs and lows increase the risk of hospitalization and complications.

Q: Can brittle diabetes be managed?

A: Yes, with advanced insulin therapies, continuous glucose monitoring, and close care.