Trouble Controlling Your Blood Sugar? It Could Be ‘Brittle Diabetes’

Help for normalizing wildly fluctuating blood glucose levels
Checking blood sugar levels that are fluctuating

Not everyone with diabetes is able to keep their blood sugar levels within a reasonable range. When blood glucose levels fluctuate from one extreme to the other every day, the patient is diagnosed with “brittle diabetes.”

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As anyone who struggles with this condition knows, blood sugar levels that go up and down cause symptoms that can be severe enough to interfere with daily life. Efforts to control these unpredictable sugar swings and the symptoms they cause can be a source of frustration that only gets worse if you are made to feel responsible.

“Some healthcare providers miss the diagnosis of brittle diabetes, because they think the patient is not being compliant,” says endocrinologist Betul Hatipoglu, MD. “However, most people try every trick in the book to bring their blood sugars in line, and nothing works.”

What causes spikes (and troughs) in blood sugar levels?

Brittle diabetes primarily occurs in people with a long history of type 1 diabetes (“juvenile diabetes”), although it can occur in those with severe type 2 diabetes who take insulin.

Over the course of many years, diabetes damages the autonomic nervous system, which governs digestion. This interferes with the normal digestive process and affects how food is absorbed.

The body cannot regulate the release of insulin appropriately. Blood sugar levels swing wildly, no matter what you do to try to stop it.

Feeling like you’re between a rock and a hard place

Symptoms caused by very high and very low blood sugar levels can be frightening, and even dangerous. The extent and severity of symptoms interfere with quality of life. Many patients are unable to hold a job, or even make advance
plans with confidence. Personal relationships can suffer. Some patients end up in the emergency department multiple times a week.

Fear of low sugar levels is compelling, because the condition can cause someone to pass out. If it happens behind the wheel of a car, the result can be tragic.

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Because it may be hard to sense when blood sugar levels are falling, some patients subconsciously keep their blood sugar levels on the high side. This is unwise, Dr. Hatipoglu emphasizes.

“High blood sugar can be as dangerous as low blood sugar — or even more so. Over time, consistently high sugar can damage the eyes and kidneys or induce coma,” she says.

How is brittle diabetes diagnosed?

If this scenario sounds familiar, Dr. Hatipoglu recommends making an appointment with an endocrinologist who specializes in diabetes.

The first step is to ensure other hormone levels are normal.

“I do a blood test to make sure something else isn’t going on, such as hypothyroidism or adrenal insufficiency,” says Dr. Hatipoglu. “These things can be easily fixed.”

If the diagnosis is brittle diabetes, Dr. Hatipoglu makes a recommendation that often surprises patients: She tells them to stop worrying so much about maintaining tight glucose control.

“I suggest they relax their Hba1c goal a bit. They are already very stressed, and it’s not necessary to be so strict,” she says.

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How to start feeling better

The good news is that new technologies can be effective in controlling blood sugar swings and help you feel better. These include continuous glucose monitoring systems and closed-loop insulin pumps.

“We don’t hesitate to recommend them, if we think they will help,” says Dr. Hatipoglu.

Sometimes, a pancreas transplant is the answer. As soon as the new pancreas produces insulin, the patient’s diabetes is cured. Yet surgery isn’t always necessary. “Closed-loop insulin pumps can be almost as effective as transplantation — although they don’t reverse the disease,” says Dr. Hatipoglu.

These options mean that brittle diabetes is no longer a life sentence. However, to take advantage of these exciting options, the problem must first be diagnosed.

“If you can’t get your blood sugar levels under control, don’t blame yourself and don’t take measures that might actually be harmful,” says Dr. Hatipoglu.

“See a diabetes expert to determine whether an advanced technology may be helpful for you.”

This article originally appeared in Cleveland Clinic Heart Advisor.

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