Is your diabetes really hard to control? Let's talk about 'Brittle Diabetes'!

Do you have diabetes? Sometimes, no matter how hard you try, take your doctor's prescribed medication on time, and control your diet, your blood sugar levels suddenly go too high or too low? Or do they suddenly go dangerously low? Does this disrupt your entire day and often require hospitalization? Then you may have a special condition that doctors call "Brittle Diabetes." Don't be scared when you hear this. Let's talk about everything simply.

Simply put, what is Brittle Diabetes?

"Brittle Diabetes" is not a new type of diabetes. It's not even an official medical diagnosis. Simply put, it's a name used to describe a very difficult, unstable condition of diabetes that is difficult to control. The word "brittle" means "easily broken." And that's exactly what this condition is. Blood glucose levels fluctuate very subtly, suddenly.

In this condition, there are frequent episodes of low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia). This can lead to frequent hospitalizations. Doctors sometimes call this ``labile diabetes''.

This condition is most common in people with type 1 diabetes . However, it can also occur in people with type 2 diabetes, who are dependent on insulin injections. Often, this "brittle diabetes" condition is caused by another medical condition or mental health problem in addition to diabetes.

Why is diabetes so difficult to control? What are the reasons?

Controlling blood sugar levels is a complex process. Many things affect it, including the food we eat, the exercise we do, stress, and hormonal changes. Most people with diabetes learn to manage these things over time. But in "brittle diabetes," the way these effects come about is unpredictable. That's why blood sugar levels can fluctuate so suddenly.

The reasons can be divided into four main categories:

1. Other medical conditions in the body.

2. Mental health problems.

3. Aging and memory loss.

4. Insulin and food safety issues.

Let's look at each of these separately.

1. Coexisting physical conditions

Some diseases can cause changes in the body's response to insulin (insulin resistance), making it difficult to control blood sugar levels.

Conditions that cause blood sugar to rise frequently:

• Hormonal imbalances: Hormone-related diseases such as hyperthyroidism (thyrotoxicosis), acromegaly, and Cushing syndrome.
• Some rare congenital conditions (congenital lipodystrophies)
• Infections that spread throughout the body (systemic infection).

Conditions that cause blood sugar to drop frequently:

• Gastroparesis: This is a condition where the food in the stomach is sent to the intestines very slowly. Imagine that you eat rice in the morning. It usually takes about two hours to digest. But because of this condition, your stomach works very slowly. So even if you inject insulin before eating, the food digests and sugar is added to the blood after 4-5 hours. In the meantime, the insulin can work and your sugar can get very low (hypoglycemia). When the food is digested, the sugar can suddenly increase very high. Do you see how difficult it is to control?
• Addison's disease: If left untreated, this condition can also cause blood sugar levels to drop frequently.
• Celiac disease: This disease prevents the body from absorbing nutrients properly, which can cause unstable blood sugar levels.

2. Mental health conditions

What we feel in our minds directly affects our bodies. Living with a chronic illness like diabetes is one of the biggest stressors.

• Severe stress, anxiety, and depression: These conditions can reduce your motivation and ability to manage your diabetes. You may forget to take your medication on time and check your blood sugar. Stress can also increase the hormones released by your body, which can increase your blood sugar levels.
• Eating disorders: Conditions like anorexia and bulimia can make it difficult to manage diabetes. Diabulimia, a condition seen in people with type 1 diabetes, involves intentionally skipping insulin doses in an attempt to lose weight. This is very dangerous.
• Drug and alcohol use: Stimulants like cocaine and opioids increase blood sugar levels. Alcohol can often cause blood sugar levels to drop dangerously low.

3. Aging and memory loss

Diabetes management is complicated by conditions such as dementia, which can occur with advancing age.

• You may forget to take your insulin dose.
• You can take a double dose by mistake.
• Short-acting and long-acting insulin types can be confused.
• Devices such as insulin pumps and continuous glucose monitors (CGMs) may not work properly.

4. Insulin and food safety issues

This is a social and economic issue that affects some people in our country as well.

• High cost of insulin: Due to the difficulty of purchasing insulin, some people use less than the prescribed dose. This can lead to dangerously high blood sugar levels and life-threatening conditions like Diabetic Ketoacidosis (DKA) .
• Lack of food security: Not eating and drinking on time can cause blood sugar levels to become unstable.

What are the symptoms of this condition?

A person with brittle diabetes mainly experiences frequent alternating symptoms of low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia).

What complications can this cause?

Constantly fluctuating blood sugar levels are not good for the body. This can lead to short-term and long-term complications.

Complications due to low blood sugar

If your blood sugar levels are low regularly, over time, you may develop a condition called hypoglycemia unawareness . This is when your body becomes accustomed to low blood sugar levels and doesn't show the warning signs of low blood sugar, such as shakiness and sweating. This is very dangerous because you can suddenly lose consciousness and have seizures without warning. If left untreated, it can even lead to death.

Complications due to high blood sugar

If blood sugar levels become uncontrolled, an emergency called diabetic ketoacidosis (DKA) can occur. This is life-threatening. Symptoms of DKA include:

• Nausea and vomiting
• Dehydration of the body
• Severe stomach pain
• Fruity breath
• Deep, rapid breathing (Kussmaul breathing)
• Heart palpitations
• Loss of consciousness and unconsciousness

Additionally, high blood sugar levels over a long period of time increase the risk of developing major complications of diabetes.

• Eye damage (Retinopathy)
• Kidney damage (Nephropathy)
• Nerve damage (Neuropathy)
• Heart disease
• Stroke

How is this treated?

The main goal of treating brittle diabetes is to find and treat the underlying cause of the unstable blood sugar levels. For example, a person with celiac disease may stabilize their blood sugar levels by following a gluten-free diet. Treating a thyroid problem may help control diabetes.

While treating the underlying cause, your doctor may suggest things like:

• Using a Continuous Glucose Monitoring (CGM) device: This device continuously monitors your blood sugar levels and gives you an alert if your sugar levels are high or low.
• Check your blood sugar levels regularly: Your doctor may ask you to check your blood sugar levels by taking a drop of blood from your finger several times a day.
• Using an insulin pump: This delivers the amount of insulin needed by the body more accurately and consistently.
• Support from a mental health professional: It is very important to see someone like a psychologist and get advice on managing things like stress and anxiety.
• Help from family or a nursing assistant: Elderly people or those with memory impairments may need help from a family member to administer insulin on time and check their blood sugar.
• Support from a social worker: Those who cannot afford insulin or are food insecure can get help finding appropriate solutions.

In very severe cases, where no other treatment can control the condition, a pancreas transplant may be recommended.

When you should seek immediate medical advice

Brittle Diabetes is not something to play with. In cases like this, it is very important to act immediately.

Managing this condition can be challenging. That's why it's important to see your doctor regularly and talk about changes in your blood sugar levels. Remember, this is not your fault. With the right treatment, the help of technology, and the support of your family, this condition can be largely controlled.

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