What is brittle diabetes and how can it affect your organs

Brittle diabetes, also known as labile diabetes, is marked by frequent spikes and drops in blood sugar levels. It is almost always a complication of type 1 diabetes - a chronic autoimmune disease in which the body doesn’t make its own insulin.

The world over, some 30 million people are living with type 1 diabetes. According to the Diabetes Atlas 2017, India has over 128,000 young people (under 25 years) living with type 1 diabetes. Another estimate puts the number of people living with type 1 diabetes in India closer to 700,000. Medical practitioners agree that the number of cases of type 1 diabetes in India is on the rise.

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Untreated, diabetes can cause wide-ranging damage to our blood vessels, eyes, heart, kidneys and brain. More so, for people living with brittle diabetes.

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How insulin works

After we eat, our body produces insulin to allow sugar to travel from the bloodstream into individual cells for producing energy. Insulin also converts extra glucose from the digestion process into glycogen for storing in the liver - for energy in-between meals.

When the body doesn’t make insulin (as in type 1 diabetes), or it makes very little insulin or is resistant to insulin (as in type 2 diabetes), there’s nothing to transfer this glucose from the blood to the cell. This can lead to hyperglycaemia, or excess of glucose in the blood, which can harm our nerves, and organs such as our kidneys and eyes.

People living with brittle diabetes need to monitor their blood sugar continually; a big drop and a big spike in blood sugar are both dangerous.

Complications of brittle diabetes

Uncontrolled diabetes can lead to acute complications like severe hypoglycemia, hyperglycemia and diabetic ketoacidosis. Unlike conditions that develop over a long time, acute conditions develop very fast - and often without warning signs.

Brittle diabetes is usually associated with type 1 diabetes, and most of the complications overlap.

Hypoglycemia or low blood sugar can occur when patients inject too much insulin or when they don’t schedule their insulin doses properly around mealtime and exercise. Severe hypoglycemia can send a diabetic into a coma and cab even lead to death - though this is rare.

Diabetic ketoacidosis is a condition in which the body starts to break down fats and muscle - in the absence of insulin, it can’t get enough glucose to fuel the brain and body. Ketones, a byproduct of fat metabolism, make the blood acidic, giving rise to diabetic ketoacidosis.

If a brittle diabetes patient's blood sugar exceeds 250mg per decilitre, they may have hyperglycemia and may be at greater risk for diabetic ketoacidosis.

Further, diabetes can cause lasting damage to the organs. Here’s a quick list of the most common problems associated with diabetes:

• Kidney problems: Sudden spikes in blood sugar can lead to renal failure. An early sign of diabetic nephropathy (kidney damage) is the presence of more albumin (a type of protein)  in the urine
• Blood vessels: Diabetes affects blood vessels, both at micro level (tiny blood vessels or capillaries) and macro level, which in turn affects our eyes, kidneys and nerves.
• Heart: According to a study by the American Diabetes Association, myocardial infarction (heart attack) is a leading cause of death in people with type 1 diabetes
• Eyes: Diabetes affects the eyes severely, leading to retinopathy or damage to the retina - in some cases, it may cause blindness. Retinopathy is more common among type 1 diabetes patients than cataract
• Nerves: Damage to the nerves (neuropathy) can lead to loss of sensation in the hands and feet. In more severe cases, it can lead to loss even cause loss of proper autonomic function such as breathing and heartbeat

Blood sugar under 70 mg/dL and over 200 mg/dL are both dangerous. In people living with brittle diabetes, blood sugar levels can swing wildly from low (hypoglycemia) to very high (hyperglycemia). In other words, it’s an unstable type 1 diabetes that can lead to life-threatening complications like diabetic ketoacidosis.

If you or a loved one has type 1 diabetes, it is extremely important to monitor blood sugar continuously and report any wild swings to your doctor.

Health articles in Firstpost are written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health. For more information on this topic, please read Diabetes: Types, Causes, Symptoms, Treatment, Precautions.