What Is Brittle Diabetes?

Medically Reviewed by Minesh Khatri, MD on September 15, 2019

Brittle diabetes is the name doctors give diabetes that is especially hard to control. It’s also called “labile” diabetes. The words brittle and labile can both mean “unstable” or “easily changed.”

When you have brittle diabetes, your blood glucose levels often swing from very low (hypoglycemic) to very high (hyperglycemic).

It's almost always associated with type 1 diabetes. It isn’t a separate kind of diabetes, but more like a complication, or subset of the disease.

Causes and Symptoms

Because any diabetes can be unstable when you don’t manage it well, a brittle diabetes diagnosis can be tricky. If your blood sugar levels swing wildly, there could be many reasons for it, including:

Often, it can be one or more of these. In many cases, doctors don’t know exactly what causes it.

Depending on which way your blood glucose level in swinging, your symptoms can be different. They're "very low" at below 70 mg/dl. Symptoms can include:

When your blood sugar shoots up above 200 mg/dl, your symptoms will likely include:

If you don’t treat high blood sugar, it can turn into a more serious condition called ketoacidosis. That's when toxins called ketones build up in your blood and urine.

It can cause:

Who Gets It?

Brittle diabetes isn't common. About 3 out of every 1,000 people who take insulin for diabetes will get it.

People of all ages can have brittle diabetes. Women get it a bit more often than men. If you often have bouts of low blood sugar, you may be raising your odds, as well. The more often you’re hypoglycemic, the less you may recognize it. That can make each episode worse and lead to brittle diabetes.

Living With It

It's a disruption to your daily life. You can’t predict when you’ll be dealing with a low or high swing in your blood glucose. Hospital stays are common. It can make it hard to work and keep up with your day-to-day tasks.

It can also be fatal.

To treat you, your doctor will work on any immediate blood sugar needs you have first. You’ll need to closely manage your diabetes. New technology and treatment options for insulin control may make it easier to regain some control.

You may get:

An insulin pump: A small machine that stays connected to you throughout the day to give you steady adjustments in insulin.

Pancreatic transplant surgery: Your pancreas is replaced by a deceased donor's pancreas to stimulate insulin production.

The treatment your doctor will choose depends on what’s causing your brittle diabetes. Once you have a plan, be sure to give yourself the best shot for success:

  • Exercise.
  • Follow your nutrition guidelines.
  • Stick to your medication schedule.
  • Most of all, stay in touch with your diabetes team so you have both the medical and emotional support you need.

If your brittle diabetes keeps you from doing work you did before, you may be able to claim Social Security Disability benefits. Check with your local Social Security Administration office for more information.

WebMD Medical Reference



Genetic and Rare Diseases Information Center: “Brittle Diabetes.”

Mirsky, S., Diabetes Survival Guide: Understanding the Facts about Diagnosis, Treatment, and Prevention, Ballantine Books, 2006.

American Diabetes Association: “Hypoglycemia (Low Blood Glucose),” “Is Diabetes a Disability?” “Living with Type 1 Diabetes.”

Mayo Clinic: “Hyperglycemia in diabetes.”

UpToDate: “The adult patient with brittle diabetes mellitus.”

Annals of Endocrinology: “Management strategies for brittle diabetes.”

National Institute of Diabetes and Digestive and Kidney Diseases: “Insulin, Medicines, & Other Diabetes Treatments,” “Pancreatic Islet Transplantation.”

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