Dealing with severe blood sugar swings can make life with diabetes seem like a roller coaster. If this is your experience, you may have brittle diabetes, which is diabetes that’s difficult to manage. Having brittle diabetes can interfere with your daily life and lead to health complications if left untreated.

“I am a brittle diabetic who’s been through almost everything diabetes-related,” one DiabetesTeam member said. Another replied, “Mine is called labile. My body keeps surprising me. I have lost 7 pounds in two weeks because of nausea. I don’t do my blood sugars often enough, but I know when I am high or low.”

Read on to discover what brittle diabetes is and who may be at risk of developing it. You’ll also learn how doctors diagnose this condition and whether any treatment options are available. To find out more about brittle diabetes, talk to your healthcare provider or an endocrinologist (hormone specialist).

What Is Brittle, Unstable, or Labile Diabetes?

Individuals with brittle diabetes have severe high and low blood sugar swings. These swings can be so frequent and severe that the person might require medical care in a hospital to recover. Most people with type 2 diabetes experience some blood sugar swings, but they’re usually not as severe as in brittle diabetes. Your doctor might also call this unstable diabetes or labile diabetes.

A healthy blood sugar range is typically between 70 and 99 milligrams per deciliter. Your body works hard to keep your blood glucose levels stable. When your levels rise or fall outside of the normal range, it can quickly become dangerous.

In most cases, doctors don’t use the term “brittle diabetes” as an official diagnosis. Instead, they’ll use the term as a way to talk about diabetes that’s hard to treat properly. Your healthcare provider can help explain why you might have brittle diabetes. They may also say that you’re experiencing hyperglycemia and/or hypoglycemia.

What Is Hyperglycemia?

Hyperglycemia means high blood sugar levels. When your fasting blood sugar level rises above 125 milligrams per deciliter or when the post-meal blood sugar level (two hours after a meal) is 180 milligrams per deciliter or higher, it’s classified as hyperglycemia.

People develop high blood sugar when they don’t make enough insulin. This hormone acts like a key that helps glucose enter your cells. Your cells then use this sugar for energy. When you don’t have enough insulin — or your cells don’t know how to use it — blood sugar builds up in your bloodstream and leads to hyperglycemia.

“Doing much better since my hyperglycemic episode landed me in the hospital last week,” one DiabetesTeam member said. “Sugars have been back to normal all week.” Another member replied, “I found out I had type 2 diabetes 14 years ago and I’m hyperglycemic.”

If you’re living with type 2 diabetes, blood sugar levels indicating hyperglycemia can vary according to your target blood sugar level goal. Always check your blood sugar levels regularly and work with your healthcare team to keep your levels at or below your target. If your hyperglycemia goes untreated for long time periods, you may experience infections and serious damage to the blood vessels, nerves, and many other tissues and organs.

What Is Hypoglycemia?

Hypoglycemia describes abnormally low blood sugar levels, typically below 70 milligrams per deciliter. Your doctor is the best person to talk to about what level is considered low for you. People with type 2 diabetes typically develop hypoglycemia if they take too much insulin or other diabetes drugs. Your blood sugar levels may drop if you don’t eat enough after giving yourself a certain insulin dose. Intense exercise can also lower your blood glucose as your cells use sugar to fuel your workout.

Sudden or dramatic increases or decreases in blood sugar levels can be dangerous and lead to life-threatening consequences if not detected early.

What Are Risk Factors for Brittle Diabetes?

Brittle diabetes is somewhat uncommon. People develop it for a variety of reasons. While it’s more common among people with type 1 diabetes, it can also affect those with type 2. Brittle diabetes is more likely to affect insulin-dependent people, meaning those who need insulin shots.

Brittle diabetes tends to develop in young adults, research indicates. Most cases affect people under the age of 40. According to Diabetes.co.uk, males are less likely to have brittle diabetes than females.

Health Conditions

Certain health conditions raise your risk of hyperglycemia and hypoglycemia. For example, you’re more likely to have high blood sugar swings if you’re living with:

• Hormonal imbalances, like Cushing’s syndrome (excess cortisol hormone), thyrotoxicosis (excess thyroid hormone), or acromegaly (excess growth hormone)
• Widespread infection in the body
• Lipodystrophy (abnormal fat loss in certain parts of the body)

Low blood sugar swings can occur from conditions that affect your digestive system. Untreated celiac disease (gluten intolerance) has been associated with type 1 diabetes. Untreated celiac disease can prevent your body from absorbing nutrients from food. Gastroparesis is a condition that slows digested food moving from your stomach to your intestines.

“It is hard to control both diabetes and gastroparesis,” one DiabetesTeam member said. Another replied, “Really struggling. I was diagnosed with diabetic gastroparesis. It has been a daily battle. My A1c jumped up to an 11.5. I have to go days without taking my metformin because I can’t keep food let alone medicine down.”

Mental Health Conditions

Your mental health affects how well you’re able to take care of yourself. People who are stressed or living with depression and/or anxiety are at risk of brittle diabetes. You may have trouble remembering to take insulin or following other healthy lifestyle choices when living with diabetes. Chronic or long-term stress can also lead to insulin resistance — meaning your cells don’t know how to use insulin properly.

Eating disorders can also lead to brittle diabetes. These may include bulimia (a condition where a person forces themselves to purge or vomit) and anorexia (a condition in which a person restricts their food intake). Consuming alcohol, opioids, and cocaine can also lead to dangerous fluctuations in blood sugar levels.

Older adults with memory problems might have trouble taking their medications correctly to manage their diabetes. People with dementia can have blood sugar swings because they forgot they already took insulin, took the wrong type or dose, or took insulin at the wrong time.

Lack of Access to Resources

Diabetes treatments — including insulin — can be expensive. Some people choose to ration their insulin, which can become dangerous. This raises your risk of extremely high blood sugar levels. Testing supplies can also be expensive. If you don’t regularly test your blood sugar with a glucose monitor, you may have problems keeping your levels in check.

Food insecurity leads to brittle diabetes as well. When you don’t have access to proper food, you may experience blood sugar swings. This can raise your average blood sugar levels over time, as measured by an A1c test.

What Are the Symptoms of Brittle Diabetes?

If you have brittle diabetes, you’ll experience frequent and sudden changes in your blood sugar levels. It’s important to know the signs of hyperglycemia and hypoglycemia so you can get treatment.

Symptoms of hyperglycemia usually look like type 2 diabetes symptoms and include:

• Weight loss
• Increased hunger and thirst
• Frequent urination
• Blurred vision
• Headaches
• Cuts and sores that don’t heal as quickly as they should
• Infections

People with brittle diabetes are also at risk of developing diabetic ketoacidosis (DKA). DKA is a life-threatening complication that occurs with extremely high blood sugar levels. If you begin experiencing any of these symptoms, get medical attention immediately:

• Abdominal pain
• Nausea
• Breath that smells fruity
• Vomiting
• Confusion or trouble thinking
• Dehydration
• Racing heartbeat

Symptoms of hypoglycemia to look out for include:

• Extreme hunger
• Sweating that leads to chills
• Trembling or shaking
• Changes in mood (irritability), trouble thinking, and disorientation
• Racing heartbeat
• Slurred speech
• Lightheadedness or feeling dizzy

How Is Brittle Diabetes Treated?

The brittle diabetes treatment plan your provider recommends will depend on what’s causing your symptoms. It could include medical devices to manage your diabetes or addressing any underlying health conditions.

Diabetes Medical Devices

If you need help controlling insulin doses, your doctor may recommend an insulin pump as part of your diabetes care plan. Insulin pumps deliver small doses of insulin throughout the day to keep your blood sugar levels in a healthy range.

A continuous glucose monitor (CGM) constantly checks your blood glucose. It alerts you when your levels rise too high or fall too low. A CGM can also find patterns so you can learn more about what may be causing your blood sugar swings. You can then develop an appropriate diabetes management plan to control your blood sugar fluctuations and improve your quality of life.

Addressing Underlying Health Conditions

If your doctor believes your brittle diabetes is due to another health condition, they’ll recommend ways to treat it. Examples include:

• Eating a gluten-free diet to treat celiac disease
• Taking medication and seeing a mental health professional to address stress, anxiety, or depression
• Changing your diet or taking medication to treat gastroparesis

If food insecurity is the issue, a social worker can help you find access to affordable diabetes treatments and resources.

Find Your Team

On DiabetesTeam, the social network for people with type 2 diabetes and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with diabetes.

Are you living with brittle diabetes? Which treatments or strategies have helped you manage it? Share your experience in the comments below, or start a conversation by posting on your Activities page.